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Eeftinck Schattenkerk LD, Musters GD, Hamming G, de Jonge WJ, van Heurn LE, Derikx JP. Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years): A retrospective analysis of incidence and risk factors using multivariate cox regression. J Pediatr Surg 2022; 57:55-60. [PMID: 35115170 DOI: 10.1016/j.jpedsurg.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adhesions following abdominal surgery can cause small bowel obstruction (SBO) necessitating surgery. Whilst some studies have addressed SBO in children, the incidence of SBO, the diseases that are of increased risk as well as risk factors in young children remain unclear. Therefore, this study aims to determine; (1) the general incidence of SBO in young children, (2) which diseases entail highest incidence of SBO and (3) risk factors for SBO in young children. STUDY DESIGN Young children (≤ 3 years of age) who underwent abdominal surgery in our tertiary referral centre between 1998-2018 were retrospectively included. Both general incidence and incidence per disease of SBO were determined. Independent risk factors for SBO were identified using cox-regression. RESULTS The incidence of SBO was 5% (N = 88/1931) in our cohort. Five of the SBOs developed following laparoscopic treatment. Patients treated for gastroschisis (17%,N = 9/53), necrotizing enterocolitis (8%,N = 15/188) and intestinal atresia (7%,N = 13/177) were at high risk of experiencing SBO. Diaphragmatic hernia (28%,N = 7/25) and meconium ileus (28%,N = 7/25) also showed high SBO proportions. Having a history of stoma (HR:3.2, 95%-CI:2.0-5.2), undergoing emergency surgery (HR:2.2, 95%-CI:1.3-3.7) and postoperative infections (HR:1.9, 95%-CI:1.2-3.1) were general risk factors for the development of SBO. CONCLUSION The incidence of SBO in young children seems higher than what has previously been reported in older children, which is why they should be studied separately. The incidence of SBO differs between diseases. Having a history of a stoma, emergency surgery and postoperative infections were independent risk factors for SBO development. Although less at risk, SBOs do develop after laparoscopies, which is why they should be included in more long-term follow-up studies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Laurens D Eeftinck Schattenkerk
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands; Medical Library, Vrije Universiteit, Amsterdam, Netherlands.
| | - Gijsbert D Musters
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands
| | - Gabriella Hamming
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands; Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Lw Ernest van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Joep Pm Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands
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Quero G, Covino M, Laterza V, Fiorillo C, Rosa F, Menghi R, Fransvea P, Cozza V, Sganga G, Franceschi F, Alfieri S. Adhesive small bowel obstruction in elderly patients: a single-center analysis of treatment strategies and clinical outcomes. Scand J Gastroenterol 2021; 56:784-790. [PMID: 33961523 DOI: 10.1080/00365521.2021.1921256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The incidence of adhesive bowel obstruction (ASBO) progressively increases with age. Strong evidences on the influencing role of age on ASBO clinical course and management are still lacking. Aim of this study is to retrospectively analyze the clinical outcomes of patients older than 65 years of age admitted to a tertiary referral Emergency Department with a diagnosis of ASBO. MATERIALS AND METHODS We reviewed the clinical records of patients admitted for ASBO in the period 2014-2019. Patients were divided in elderly (≥65 years) and non-elderly (<65 years). Primary endpoint was to compare the all-cause in-hospital mortality and the occurrence of major complications in the two groups. Secondary endpoint was a comparison of clinical presentation, clinical course and management. RESULTS We enrolled 285 elderly and 492 non-elderly patients. Vomit was more frequent in the elderly (51.9% vs 34.6%; p < .001), while no difference was evidenced for the remaining symptoms of ASBO presentation. A higher rate of non-operative management (NOM) (26.3% vs 16.5%; p = .010), ICU admission (16% vs 0.6%; p < .001), mortality (2.1% vs 0.2%; p = .007) and cumulative major complications (8.8% vs 3.3%; p = .001), as well as a prolonged hospitalization (8.2 vs 5.4 days; p < .001) was evidenced in the ≥65 years group. Multivariate analysis identified increasing age (OR:2.8; 95%CI:1.09-7.2; p = .040) and Charlson comorbidity index ≥ 2 (OR:2.5; 95% CI:1.2-6.4; p = .050) as the only independent predictors of cumulative major complications. CONCLUSIONS Despite the similarity in terms of clinical presentation, elderly patient present higher mortality rate and occurrence of major complications. A comprehensive geriatric assessment is recommended to optimize the diagnostic and clinical strategies in case of ASBO.
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Affiliation(s)
- Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy.,Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Marcello Covino
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,Emergency Medicine, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Vito Laterza
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Fausto Rosa
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy.,Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| | - Roberta Menghi
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Valerio Cozza
- Emergency Surgery, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Gabriele Sganga
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,Emergency Surgery, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Francesco Franceschi
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,Emergency Medicine, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli IRCCS di Roma, Rome, Italy.,Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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Feng W, Du XB, Zhao XF, Li MM, Cui HL. Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis. Pediatr Surg Int 2021; 37:745-754. [PMID: 33538868 DOI: 10.1007/s00383-021-04862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction. METHODS From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction. RESULTS Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9. CONCLUSION Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.
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Affiliation(s)
- Wei Feng
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Xiao-Bing Du
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Xu-Feng Zhao
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Miao-Miao Li
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Hua-Lei Cui
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China.
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Lauriti G, Miscia ME, Cascini V, Chiesa PL, Pierro A, Zani A. Intestinal malrotation in infants with omphalocele: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:378-82. [PMID: 30309732 DOI: 10.1016/j.jpedsurg.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The management of intestinal malrotation in infants with omphalocele varies among surgeons. Herein, we aimed to determine whether infants with omphalocele should be investigated for malrotation. METHODS Using a defined search strategy, three investigators identified all studies reporting patients with omphalocele and malrotation. Outcome measures included: 1. incidence of malrotation; 2. correlation with the abdominal size defect in patients with omphalocele; 3. risk of volvulus in those not investigated for malrotation; 4. incidence of adhesive bowel obstruction in those who underwent Ladd's procedure. The meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3. RESULTS Of 111 articles analyzed, 12 (3888 children) reported malrotation in 136 patients (3.5%). Malrotation was equally found in patients with major (15.2%) and minor (13.6%; p = 0.52) omphalocele. A volvulus was more common in children who had Ladd's procedure (8%) than in those who did not (1%; p = 0.03). Adhesive bowel obstruction rate was similar in both groups (5% vs. 3%; p = 0.21). CONCLUSION The incidence of malrotation in infants with omphalocele is low but probably underreported, and is not influenced by the size of the defect. At present, there is no evidence in the literature to support investigations to detect malrotation in infants with omphalocele. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE III.
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Norrbom C, Steding-Jessen M, Agger CT, Osler M, Krabbe-Sorensen M, Settnes A, Nilas L, Loekkegaard ECL. Risk of adhesive bowel obstruction after abdominal surgery. A national cohort study of 665,423 Danish women. Am J Surg 2018; 217:694-703. [PMID: 30420091 DOI: 10.1016/j.amjsurg.2018.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated. METHOD In a national cohort of all Danish women with an abdominal operation (N = 665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year. RESULTS In the cohort, 1.4% experienced an episode of adhesive bowel obstruction. The risk increased 33-43% during the study period, was lower after gynecological and obstetrical procedures compared to gastrointestinal (HR 0.36 [0.34-0.38]), lower after laparoscopic compared to laparotomic surgery (HR 0.51 [0.48-0.54]) and increased proportionally after each additional operation. CONCLUSIONS The risk of adhesive bowel obstruction after abdominal operations depends on the site of earlier operations, the method of access and the number of earlier operations.
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Affiliation(s)
- Christina Norrbom
- Department of Obstetrics and Gynecology, North Zealand Hospital Hilleroed, Dyrehavevej 29, 3400, Hilleroed, Denmark.
| | - Marianne Steding-Jessen
- The Danish Clinical Registries, Department. for Cancer and Cancer Screening, Central Region of Denmark, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Carsten Thye Agger
- Center for Clinical Research and Disease Prevention, Frederiksberg and Bispebjerg Hospitals, Denmark, Hovedvejen, indgang 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Merete Osler
- Center for Clinical Research and Disease Prevention, Frederiksberg and Bispebjerg Hospitals, Denmark, Hovedvejen, indgang 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, København K, Denmark.
| | - Marie Krabbe-Sorensen
- Stork Fertility Clinique, Copenhagen, Store Kongensgade 40H, 1. sal, 1264, København K, Denmark.
| | - Annette Settnes
- Department of Obstetrics and Gynecology, North Zealand Hospital Hilleroed, Dyrehavevej 29, 3400, Hilleroed, Denmark.
| | - Lisbeth Nilas
- Gynecological Department, Hvidovre Hospital, Denmark
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