Skip to main content

Advertisement

SpringerLink
Log in

Paediatric adhesive bowel obstruction: a systematic review

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

This article has been updated

Abstract

Adhesions following abdominal surgery remain a common cause of bowel obstruction. The incidence is between 1 and 12.6% in children who have had previous abdominal surgery. While conservative management is usually trialled in all patients (including children) suspected of having ASBO, the majority will require surgical intervention. New materials such as Seprafilm® have been studied in the paediatric population, with promising results of its use in index abdominal surgeries to prevent the formation of adhesions. In this article, we conducted a systematic review to present an overview of the current knowledge on the incidence, aetiology, pathophysiology, clinical presentation, and management of ASBO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

  • 03 May 2021

    Article category has been updated.

Abbreviations

ASBO:

Adhesive small bowel obstruction

EMT:

Epithelial-mesenchymal transition

FMF:

Familial Mediterranean fever

HLA:

Human leukocyte antigen

MIS:

Minimally invasive surgery

PELA:

Paediatric emergency laparotomy audit

POCUS:

Point-of-care US

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SBO:

Small bowel obstruction

References

  1. Håkanson CA, Fredriksson F, Lilja HE (2020) Adhesive small bowel obstruction after appendectomy in children—laparoscopic versus open approach. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2020.02.024

    Article  PubMed  Google Scholar 

  2. Fredriksson F, Christofferson RH, Lilja HE (2016) Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg 103(3):284–289. https://doi.org/10.1002/bjs.10072

    Article  CAS  PubMed  Google Scholar 

  3. Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 126(3):345–353

    Article  CAS  PubMed  Google Scholar 

  4. Lautz TB, Barsness KA (2014) Adhesive small bowel obstruction–acute management and treatment in children. Semin Pediatr Surg 23(6):349–352. https://doi.org/10.1053/j.sempedsurg.2014.06.006

    Article  PubMed  Google Scholar 

  5. Miyake H, Seo S, Pierro A (2018) Laparoscopy or laparotomy for adhesive bowel obstruction in children: a systematic review and meta-analysis. Pediatr Surg Int 34(2):177–182. https://doi.org/10.1007/s00383-017-4186-0

    Article  PubMed  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  7. Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E (2007) Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever–are they more frequent? Semin Arthritis Rheum 36(5):316–321. https://doi.org/10.1016/j.semarthrit.2006.11.002

    Article  PubMed  Google Scholar 

  8. James V, Alsani FS, Fregonas C, Seguin J, Tessaro MO (2016) Point-of-care ultrasound in pediatric small bowel obstruction: an ED case series. Am J Emerg Med 34 (12):2464.e2461–2464.e2462. https://doi.org/10.1016/j.ajem.2016.06.021

  9. Bing L, Wei-Bing C, Shou-Qing W, Ye-Bo W (2014) Acquired ileal atresia induced by adhesive intestinal obstruction. Indian J Pediatr 81(5):507–508. https://doi.org/10.1007/s12098-013-1281-7

    Article  PubMed  Google Scholar 

  10. Grant HW, Parker MC, Wilson MS, Menzies D, Sunderland G, Thompson JN, Clark DN, Knight AD, Crowe AM, Ellis H (2008) Adhesions after abdominal surgery in children. J Pediatr Surg 43 (1):152–156. https://doi.org/10.1016/j.jpedsurg.2007.09.038(discussion 156–157)

  11. Sinha CK, Rye E, Sunderland R, Rex D, Nicholls E, Okoye B (2020) The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK. Ann R Coll Surg Engl 102(3):209–213. https://doi.org/10.1308/rcsann.2019.0141

    Article  CAS  PubMed  Google Scholar 

  12. Young JY, Kim DS, Muratore CS, Kurkchubasche AG, Tracy TF Jr, Luks FI (2007) High incidence of postoperative bowel obstruction in newborns and infants. J Pediatr Surg 42 (6):962–965. https://doi.org/10.1016/j.jpedsurg.2007.01.030(discussion 965)

  13. Choudhry MS, Grant HW (2006) Small bowel obstruction due to adhesions following neonatal laparotomy. Pediatr Surg Int 22(9):729–732. https://doi.org/10.1007/s00383-006-1719-3

    Article  PubMed  Google Scholar 

  14. Yokota K, Uchida H, Kaneko K, Ono Y, Murase N, Makita S, Hayakawa M (2014) Surgical complications, especially gastroesophageal reflux disease, intestinal adhesion obstruction, and diaphragmatic hernia recurrence, are major sequelae in survivors of congenital diaphragmatic hernia. Pediatr Surg Int 30(9):895–899. https://doi.org/10.1007/s00383-014-3575-x

    Article  PubMed  Google Scholar 

  15. Molinaro F, Kaselas C, Lacreuse I, Moog R, Becmeur F (2009) Postoperative intestinal obstruction after laparoscopic versus open surgery in the pediatric population: a 15-year review. Eur J Pediatr Surg 19(3):160–162. https://doi.org/10.1055/s-0029-1202858

    Article  CAS  PubMed  Google Scholar 

  16. Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J (2018) Postoperative small bowel obstruction following laparoscopic or open fundoplication in children: a retrospective analysis using a nationwide database. World J Surg 42(12):4112–4117. https://doi.org/10.1007/s00268-018-4735-2

    Article  PubMed  Google Scholar 

  17. Tsao KJ, St Peter SD, Valusek PA, Keckler SJ, Sharp S, Holcomb GW 3rd, Snyder CL, Ostlie DJ (2007) Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 42(6):939–942. https://doi.org/10.1016/j.jpedsurg.2007.01.025(discussion 942)

  18. Chang YJ, Yan DC, Lai JY, Chao HC, Chen CL, Chen SY, Tsai MH (2017) Strangulated small bowel obstruction in children. J Pediatr Surg 52(8):1313–1317. https://doi.org/10.1016/j.jpedsurg.2017.03.002

    Article  PubMed  Google Scholar 

  19. Johnson BL, Campagna GA, Hyak JM, Vogel AM, Fallon SC, Shah SR, Brandt ML, Naik-Mathuria BJ (2020) The significance of abdominal radiographs with paucity of gas in pediatric adhesive small bowel obstruction. Am J Surg 220(1):208–213. https://doi.org/10.1016/j.amjsurg.2019.10.035

    Article  PubMed  Google Scholar 

  20. Hughes UM, Thomas KE, Shuckett B, Daneman A, Stephens D (2002) The abdominal radiographic series in children with suspected bowel obstruction–should the second view be abandoned? Pediatr Radiol 32(8):556–560. https://doi.org/10.1007/s00247-002-0725-4

    Article  PubMed  Google Scholar 

  21. Nasir AA, Abdur-Rahman LO, Bamigbola KT, Oyinloye AO, Abdulraheem NT, Adeniran JO (2013) Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children? Afr J Paediatr Surg 10(3):259–264. https://doi.org/10.4103/0189-6725.120908

    Article  PubMed  Google Scholar 

  22. Lee CY, Hung MH, Lin LH, Chen DF (2015) Evaluation of a water-soluble contrast agent for the conservative management of adhesive small bowel obstruction in pediatric patients. J Pediatr Surg 50(4):581–585. https://doi.org/10.1016/j.jpedsurg.2014.11.034

    Article  CAS  PubMed  Google Scholar 

  23. Osifo OD, Ovueni ME (2010) Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country? Afr J Paediatr Surg 7(2):66–70. https://doi.org/10.4103/0189-6725.62843

    Article  PubMed  Google Scholar 

  24. Lautz TB, Raval MV, Reynolds M, Barsness KA (2011) Adhesive small bowel obstruction in children and adolescents: operative utilization and factors associated with bowel loss. J Am Coll Surg 212(5):855–861. https://doi.org/10.1016/j.jamcollsurg.2011.01.061

    Article  PubMed  Google Scholar 

  25. Hyak J, Campagna G, Johnson B, Stone Z, Yu Y, Rosenfeld E, Zhang W, Naik-Mathuria B (2019) Management of pediatric adhesive small bowel obstruction: do timing of surgery and age matter? J Surg Res 243:384–390. https://doi.org/10.1016/j.jss.2019.05.061

    Article  PubMed  Google Scholar 

  26. Deng Y, Wang Y, Guo C (2019) Prediction of surgical management for operated adhesive postoperative small bowel obstruction in a pediatric population. Medicine 98(11):e14919. https://doi.org/10.1097/md.0000000000014919

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lee J, Tashjian DB, Moriarty KP (2012) Surgical management of pediatric adhesive bowel obstruction. J Laparoendosc Adv Surg Tech A 22(9):917–920. https://doi.org/10.1089/lap.2012.0069

    Article  PubMed  Google Scholar 

  28. Alemayehu H, David B, Desai AA, Iqbal CW, St Peter SD (2015) Laparoscopy for small bowel obstruction in children–an update. J Laparoendosc Adv Surg Tech A 25(1):73–76. https://doi.org/10.1089/lap.2014.0228

    Article  PubMed  Google Scholar 

  29. Feigin E, Kravarusic D, Goldrat I, Steinberg R, Dlugy E, Baazov A, Zer M, Freud E (2010) The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction. J Pediatr Surg 45(5):966–968. https://doi.org/10.1016/j.jpedsurg.2010.02.025

    Article  PubMed  Google Scholar 

  30. Holland-Cunz S, Boelter AV, Waag KL (2003) Protective fibrin-sealed plication of the small bowel in recurrent laparotomy. Pediatr Surg Int 19(7):540–543. https://doi.org/10.1007/s00383-003-0987-4

    Article  CAS  PubMed  Google Scholar 

  31. Valkodai RR, Gurusami R, Duraisami V (2012) Postoperative adhesive intestinal obstruction: the role of intestinal stenting. J Indian Assoc Pediatr Surg 17(1):20–22. https://doi.org/10.4103/0971-9261.91081

    Article  PubMed  PubMed Central  Google Scholar 

  32. Erdoğan E, Celayir S, Eroğlu E, Yilmaz E (2000) The relation between human leukocyte antigen (HLA) distribution and intestinal obstruction and adhesions in childhood: preliminary report. Pediatr Surg Int 16(5–6):374–376. https://doi.org/10.1007/s003830000350

    Article  PubMed  Google Scholar 

  33. Junga A, Pilmane M, Ābola Z, Volrāts O (2019) The morphopathogenetic aspects of intraabdominal adhesions in children under one year of age. Medicina (Kaunas, Lithuania) 55 (9). https://doi.org/10.3390/medicina55090556

  34. Foster DS, Marshall CD, Gulati GS, Chinta MS, Nguyen A, Salhotra A, Jones RE, Burcham A, Lerbs T, Cui L, King ME, Titan AL, Ransom RC, Manjunath A, Hu MS, Blackshear CP, Mascharak S, Moore AL, Norton JA, Kin CJ, Shelton AA, Januszyk M, Gurtner GC, Wernig G, Longaker MT (2020) Elucidating the fundamental fibrotic processes driving abdominal adhesion formation. Nat Commun 11(1):4061. https://doi.org/10.1038/s41467-020-17883-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Bonnard A, Kohaut J, Sieurin A, Belarbi N, El Ghoneimi A (2011) Gastrografin for uncomplicated adhesive small bowel obstruction in children. Pediatr Surg Int 27(12):1277–1281. https://doi.org/10.1007/s00383-011-2963-8

    Article  CAS  PubMed  Google Scholar 

  36. Linden AF, Raiji MT, Kohler JE, Carlisle EM, Pelayo JC, Feinstein K, Kandel JJ, Mak GZ (2019) Evaluation of a water-soluble contrast protocol for nonoperative management of pediatric adhesive small bowel obstruction. J Pediatr Surg 54(1):184–188. https://doi.org/10.1016/j.jpedsurg.2018.10.002

    Article  PubMed  Google Scholar 

  37. Inoue M, Uchida K, Otake K, Nagano Y, Ide S, Hashimoto K, Matsushita K, Koike Y, Mohri Y, Kusunoki M (2013) Efficacy of Seprafilm for preventing adhesive bowel obstruction and cost-benefit analysis in pediatric patients undergoing laparotomy. J Pediatr Surg 48(7):1528–1534. https://doi.org/10.1016/j.jpedsurg.2013.01.028

    Article  PubMed  Google Scholar 

  38. Bracho-Blanchet E, Dominguez-Muñoz A, Fernandez-Portilla E, Zalles-Vidal C, Davila-Perez R (2017) Predictive value of procalcitonin for intestinal ischemia and/or necrosis in pediatric patients with adhesive small bowel obstruction (ASBO). J Pediatr Surg 52(10):1616–1620. https://doi.org/10.1016/j.jpedsurg.2017.07.006

    Article  PubMed  Google Scholar 

  39. Nataraja RM, Panabokke G, Chang AD, Mennie N, Tanny ST, Keys C, Cheng W, Pacilli M, Ferguson P (2019) Does peritoneal lavage influence the rate of complications following pediatric laparoscopic appendicectomy in children with complicated appendicitis? A prospective randomized clinical trial. J Pediatr Surg 54(12):2524–2527. https://doi.org/10.1016/j.jpedsurg.2019.08.039

    Article  PubMed  Google Scholar 

  40. Lakshminarayanan B, Hughes-Thomas AO, Grant HW (2014) Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg 23(6):344–348. https://doi.org/10.1053/j.sempedsurg.2014.06.005

    Article  PubMed  Google Scholar 

  41. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE (2016) Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol 23(5):559–568. https://doi.org/10.1016/j.acra.2015.12.014

    Article  CAS  PubMed  Google Scholar 

  42. Hajivassiliou CA (2003) Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg 12(4):241–253. https://doi.org/10.1053/j.sempedsurg.2003.08.005

    Article  CAS  PubMed  Google Scholar 

  43. Anderson SA, Beierle EA, Chen MK (2014) Role of laparoscopy in the prevention and in the treatment of adhesions. Semin Pediatr Surg 23(6):353–356. https://doi.org/10.1053/j.sempedsurg.2014.06.007

    Article  PubMed  Google Scholar 

  44. Markar SR, Penna M, Harris A (2014) Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg 18(9):1683–1692. https://doi.org/10.1007/s11605-014-2572-7

    Article  PubMed  Google Scholar 

  45. Lin LH, Lee CY, Hung MH, Chen DF (2014) Conservative treatment of adhesive small bowel obstruction in children: a systematic review. BMJ Open 4(9):e005789. https://doi.org/10.1136/bmjopen-2014-005789

    Article  PubMed  PubMed Central  Google Scholar 

  46. ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bakkum EA, Rovers MM, van Goor H (2013) Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 347:f5588. https://doi.org/10.1136/bmj.f5588

    Article  PubMed  PubMed Central  Google Scholar 

  47. Maki Y, Bos TJ, Davis C, Starbuck M, Vogt PK (1987) Avian sarcoma virus 17 carries the jun oncogene. Proc Natl Acad Sci U S A 84(9):2848–2852. https://doi.org/10.1073/pnas.84.9.2848

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Noble TB (1937) Plication of small intestine as prophylaxis against adhesions. Am J Surg 35(1):41–44. https://doi.org/10.1016/S0002-9610(37)91032-8

    Article  Google Scholar 

  49. Childs WA, Phillips RB (1960) Experience with intestinal plication and a proposed modification. Ann Surg 152(2):258–265. https://doi.org/10.1097/00000658-196008000-00007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Liverpool Hospital, Liverpool, NSW, Australia

    Alexander T. M. Nguyen

  2. South West Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia

    Alexander T. M. Nguyen

  3. The Burns Unit, The Children’s Hospital at Westmead Burns Research Institute, Westmead, NSW, Australia

    Andrew J. A. Holland

  4. Douglas Cohen Department of Paediatric Surgery, The Children’s Hospital at Westmead Clinical School, The Faculty of Medicine and Health, The University of Sydney, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia

    Andrew J. A. Holland

Authors
  1. Alexander T. M. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew J. A. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the article conception and design. The literature search, screening, compilation, critical analysis and synthesis were conducted by ATMN. The first draft of the manuscript was written by ATMN. Critical revisions were provided by AJAH. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrew J. A. Holland.

Ethics declarations

Conflict of interest

The authors did not receive funds, grants, or any other support from any organisation for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, A.T.M., Holland, A.J.A. Paediatric adhesive bowel obstruction: a systematic review. Pediatr Surg Int 37, 755–763 (2021). https://doi.org/10.1007/s00383-021-04867-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-04867-5

Keywords

Search

Navigation