TÇCD 2011 29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Introduction: ASBO is a common problem in children with previous abdominal surgery. Management protocols usually start with conservative approach that may be successful in some cases, whereas in others it will end eventually by laparotomy. Our aim was to assess the role of gastrografin in the conservative management of ASBO. Patients and methods: During the period January 2009 to July 2010, 33 patients with ASBO were presented at the Pediatric Surgery Unit at the Ain Shams University Hospitals. Patients who failed to improve after 48 h of conservative management in the absence of signs of strangulation were subjected to gastrografin administration. Patients were evaluated clinically and radiologically to determine the resolution of the adhesive attack, with estimation of hospital stay time. Results: 33 patients were admitted for 35 attacks of ASBO. Four patients were explored immediately after initial resuscitation. After 48 h of conservative management, seventeen attacks had resolved, while two cases were explored within this period. The remaining 12 attacks were subjected to gastrografin administration. Eight (66.6%) of them had their attack clinically and radiologically resolved within 3–12 h (average 7.5 h). Their average hospital stay after gastrografin administration was 19.25 h. The other four patients were explored, as the contrast showed complete small bowel obstruction with failure to reach the cecum. Conclusion: Gastrografin may have a valuable role in the management of ASBO, whether diagnostic or therapeutic, but a randomized controlled trial is needed to prove its effectiveness in reducing surgical intervention rate and hospital stay time.