Laparoscopy in Management of Children with Small Bowel Obstruction

Small bowel obstruction caused by adhesions is one of the most common causes of hospital admission among children. Until recently, the presence of symptoms of small bowel obstruction was the contraindication for laparoscopy; however, rapid development of minimally-invasive surgery determined the implementation of these methods in the management of patients with small bowel obstruction.The objective of the research was to summarize our own experience of laparoscopic treatment of children with small bowel obstruction.Materials and methods. The study is based on the results of laparoscopic management of 86 children being operated on during 2007-2015. Laparoscopy was used in 90.7% of patients and laparoscopically assisted procedures were performed in 9.3% of cases. Results. Adhesive small bowel obstruction occurred more often after laparotomy (70.9%), while after laparoscopy it was detected in 16.3% of patients only. During surgical revision of the abdominal cavity, single obstructive bands often in the area of the ileocecal valve were found in 55.8% patients; diffuse dense bands were observed in 31.4% of children; in 12.8% of children twisting of a loop of small bowel around the Meckel’s diverticulum was noted. Laparoscopically assisted procedures were applied in cases that required bowel resection. The postoperative complication rate was 9.3%.Conclusions. In the presence of appropriate skills, laparoscopic adhesiolysis can be a real alternative to conventional laparotomy in treating children with small bowel obstruction. The usage of remedies with anti-adhesive properties improves the results of treating children with bowel obstruction.

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Delayed primary fascia closure of Björck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report

BMC Surgery ◽

10.1186/s12893-021-01329-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshimasa Akashi ◽

Koichi Ogawa ◽

Kaoru Sasaki ◽

Jaejeong Kim ◽

Tsuyoshi Enomoto ◽

...

Keyword(s):

Small Bowel ◽

Parenteral Nutrition ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Abdomen ◽

Abdominal Cavity ◽

Wound Management ◽

Adhesive Small Bowel Obstruction ◽

Proximal Site ◽

Fascia Closure

Abstract Background An open abdomen with frozen adherent bowels is classified as grade 4 in Björck’s open abdomen classification, and skin grafting after wound granulation is a typical closure option. We achieved delayed primary fascia closure for a patient who developed open abdomen with enteroatmospheric fistulas due to severe adherent small bowel obstruction. We present here the details of his management. Case presentation A 52-year-old man suffered acute abdominal pain during a flight and received an emergency laparotomy due to adhesive small bowel obstruction. Repeated laparotomies were required, and later open abdomen and proximal site jejunostomy were selected. After negative pressure wound therapy, he was transferred to our institution. Two enteroatmospheric fistulas emerged on the exposed intestine, and we diagnosed the condition as a Björck grade 4 open abdomen. After 8 months of wound care and parenteral nutrition, we decided to attempt primary wound closure because the patient required permanent oral restriction and total parenteral nutrition due to short bowel syndrome. A circular incision along the circumference of the exposed bowel allowed us to take a safe approach into the abdominal cavity. We removed the intestinal adhesions completely and resected the bowels, including the fistulas and anastomosed parts. Finally, the abdominal wall defect was reconstructed using the component separation technique, and the patient was discharged without an ostomy. Conclusions Primary fascia closure for grade 4 open abdomen is hard, but leaving a long interval before radical surgery and applying pertinent wound management may help solve this adverse situation.

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Value of the ultrasound research in the diagnostic of acute strangulated small bowel obstruction

Medical Visualization ◽

10.24835/1607-0763-875 ◽

2021 ◽

Vol 25 (3) ◽

pp. 31-42

Author(s):

N. V. Shavrina ◽

P. A. Yartsev ◽

A. G. Lebedev ◽

V. D. Levitsky ◽

M. N. Drаyer ◽

...

Keyword(s):

Blood Flow ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Intestinal Ischemia ◽

Comparison Group ◽

Abdominal Cavity ◽

Intestinal Wall ◽

Adhesive Small Bowel Obstruction ◽

Intestinal Necrosis

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

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Adhesive Small Bowel Obstruction Protocol in Geriatric Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.200 ◽

2019 ◽

Vol 229 (4) ◽

pp. S87

Author(s):

Jose A. Aldana ◽

Javier E. Rincon ◽

Ricardo A. Fonseca ◽

Rohit K. Rasane ◽

Christina X. Zhang ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Geriatric Patients ◽

Adhesive Small Bowel Obstruction

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Sex differences in non‐strangulated postoperative adhesive small bowel obstruction: A retrospective cohort study

ANZ Journal of Surgery ◽

10.1111/ans.17103 ◽

2021 ◽

Author(s):

Yuta Yamamoto ◽

Yusuke Miyagawa ◽

Masato Kitazawa ◽

Makoto Koyama ◽

Satoshi Nakamura ◽

...

Keyword(s):

Sex Differences ◽

Cohort Study ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adhesive Small Bowel Obstruction

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Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

Scandinavian Journal of Surgery ◽

10.1177/1457496920982763 ◽

2021 ◽

pp. 145749692098276

Author(s):

M. Podda ◽

M. Khan ◽

S. Di Saverio

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Conservative Management ◽

Bowel Ischemia ◽

Current Evidence ◽

First Episode ◽

Adhesive Small Bowel Obstruction ◽

Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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