A Study of Postoperative Adhesive Intestinal Obstruction in Children

This study analyses 47 cases with acute postoperative adhesive intestinal obstruction who were treated under 15 years old at Ewha Womans University Hospital during Junuary 1985 to December 1992.

Fourty-seven cases is 2.5 per cent of 1943 pediatric surgical cases who were treated during same period. In 47 cases, 29 cases were treated with surgical interventions(17 cases with the immediate operation and 12 cases with the delayed operation) and 18 cases were treated with nonsurgical management. Male to female sex ratio is 3 : 2. The incidence is higher in older age groups. The age distribution of 47 cases who underwent a previous peritoneal procedure were 4 cases in neonate, 13 cases in infants, 12 cases in preschool age and 18 cases in early school age & adolescence. Eighty-five per cent of the cases had only one prior peritoneal procedure and the most common previous condition necessitating laparotomy was acute appendicitis(57.4%), intussusception(21.3%), and developmental anomalies(19.1%). More than 50% of the intestinal obstructions developed more than 3 months later of prior laparotomy. The common clinical findings were similar to the intestinal obstruction developed by other causes and 85% of the cases were admitted within 72 hours of developing the symptoms of obstruction. The success rate of conservative trial was 60 per cent and in more than 60% of surgical treatment group, the only surgical interventions were lysis of fibrous band or adhesions caused intestinal obstruction. There was no death.

This results suggest that the need for too little late surgical intervention to prevent the circulatory disturbances can not be over emphasized. Because, there was no criteria to predict the success of conservative trial and there was no significant difference of clinical and radiologic findings between surgical and conservative treatment groups.