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Bowel obstruction without history of laparotomy: Clinical analysis of 70 patients
Author(s) -
Yoshimaru Koichiro,
Kinoshita Yoshiaki,
Matsuura Toshiharu,
Esumi Genshiro,
Wada Momoko,
Takahashi Yoshiaki,
Yanagi Yusuke,
Hayashida Makoto,
Ieiri Satoshi,
Taguchi Tomoaki
Publication year - 2016
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13003
Subject(s) - medicine , laparotomy , intussusception (medical disorder) , volvulus , meckel's diverticulum , diverticulum (mollusc) , bowel resection , etiology , surgery , bowel obstruction , segmental resection , internal hernia , hernia , resection , general surgery
Background Determining the cause of bowel obstruction without a history of laparotomy (BO without HL) is difficult and can result in delay of treatment and development of a potentially life‐threatening situation. We herein investigated the clinical characteristics of pediatric patients who underwent laparotomy due to BO without HL. Methods All surgical pediatric patients aged <16 age who were diagnosed with BO without HL between January 2004 and September 2014 were included. Etiology of BO, intraoperative findings and postoperative outcome were investigated retrospectively. Results Seventy patients were diagnosed with BO without HL in this period. In these 70 patients, malrotation ( n = 34), intussusception ( n = 19), internal hernia ( n = 6) and Meckel's diverticulum ( n = 5) were predominantly identified. Regarding preoperative definitive diagnosis, prevalence of internal hernia, Meckel's diverticulum or idiopathic volvulus was significantly lower than that of malrotation or intussusception ( P < 0.05). Intraoperatively, the rates of strangulation and bowel resection were 55.7% and 30.0%, respectively. The optimal time for emergency operation in order to avoid strangulated bowel resection was <19 h from onset of symptoms. Conclusions Malrotation and intussusception are major causes of BO without HL in children, but internal hernia, Meckel's diverticulum and idiopathic volvulus should always be taken into account, particularly because of the preoperative diagnostic difficulty and resulting high rate of intestinal resection. In order to avoid resection of the bowel, surgery should be done within 19 h before bowel ischemic change occurs.