Journal of pediatric surgery · 2026
Recurrent Small Bowel Obstruction Following Contrast Challenge Versus Surgical Intervention at Index Presentation:1-Year Follow-Up of the Adhesive Bowel Obstruction in Children (ABC) Study.
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Speck K Elizabeth, Gilliam Elizabeth A, Van Arendonk Kyle J, Hirschl Ronald B, Goldstein Seth D, Leys Charles M, Markel Troy A, Rymeski Beth, Wright Tiffany, St Peter Shawn D, Lal Dave R, Mak Grace, Shah Nikhil R, Halaweish Ihab F, Bergus Katherine C, Criss Cory N, Ayala Samantha A, Zeineddin Suhail, Joshi Devashish S, Landman Matthew P, Mannava Sindhu, Trinidad Stephen, Carter Stewart R, Georgeades Christina, Yeh Andrew, Shakhsheer Baddr, Flynn-O'Brien Katherine T, Minneci Peter C, Midwest Pediatric Surgery Consortium
Аннотация
AIM: Long-term outcomes after contrast challenge (CC) in pediatric adhesive small bowel obstruction (ASBO) are unknown. This study assesses ASBO recurrence and need for surgical intervention within 1-year of ASBO admission.
METHODS: We performed a multi-institutional prospective implementation study of a standardized CC algorithm in children (<18years) admitted with ASBO (10/2021-09/2024). Patients requiring urgent/emergent surgery were excluded. Readmission for ASBO recurrence was monitored for 1 year after index admission. Nonparametric tests were performed to compare groups.
RESULTS: Of the 264 patients enrolled, 262 patients (99%) were alive for 1-year follow-up; neither death was related to ASBO or CC exposure. Within 1 year, 35 patients (13%) had a recurrent ASBO; 19 (54%) were ultimately managed surgically. Recurrence was not associated with prior contrast administration (14% CC vs 12% no CC; p=0.70) or failure of non-operative (12% surgery vs 14% no surgery; p=0.55). Similarly, failure of NOM for recurrent ASBO (NOM) was not different based on CC (50% CC vs 67% no CC; p=0.39) or prior failure of NOM (73% previous failed NOM vs 45% successful NOM; p=0.14). There was no difference in recurrence based on NOM outcome in CC patients (15% successful NOM vs 11% failed NOM, p=0.51).
CONCLUSION: In the largest, prospective pediatric ASBO study, the 1-year ASBO recurrence rate was 13%, regardless of prior management strategy - neither contrast challenge nor surgery at index admission for ASBO affected ASBO recurrence or subsequent failure of NOM. Utilizing a CC for recurrent ASBO remains a valuable diagnostic tool to discern operative needs.
METHODS: We performed a multi-institutional prospective implementation study of a standardized CC algorithm in children (<18years) admitted with ASBO (10/2021-09/2024). Patients requiring urgent/emergent surgery were excluded. Readmission for ASBO recurrence was monitored for 1 year after index admission. Nonparametric tests were performed to compare groups.
RESULTS: Of the 264 patients enrolled, 262 patients (99%) were alive for 1-year follow-up; neither death was related to ASBO or CC exposure. Within 1 year, 35 patients (13%) had a recurrent ASBO; 19 (54%) were ultimately managed surgically. Recurrence was not associated with prior contrast administration (14% CC vs 12% no CC; p=0.70) or failure of non-operative (12% surgery vs 14% no surgery; p=0.55). Similarly, failure of NOM for recurrent ASBO (NOM) was not different based on CC (50% CC vs 67% no CC; p=0.39) or prior failure of NOM (73% previous failed NOM vs 45% successful NOM; p=0.14). There was no difference in recurrence based on NOM outcome in CC patients (15% successful NOM vs 11% failed NOM, p=0.51).
CONCLUSION: In the largest, prospective pediatric ASBO study, the 1-year ASBO recurrence rate was 13%, regardless of prior management strategy - neither contrast challenge nor surgery at index admission for ASBO affected ASBO recurrence or subsequent failure of NOM. Utilizing a CC for recurrent ASBO remains a valuable diagnostic tool to discern operative needs.