R. E. Overman1, M. Hilu1, S. Gadepalli1 1University Of Michigan,Pediatric Surgery,Ann Arbor, MI, USA
Introduction:
Early post-operative small bowel obstruction (EPSBO) is a known complication of abdominal surgery affecting 0.7-3.0% of patients. This has traditionally been managed similarly to adhesive small bowel obstructions, though literature describing this clinical entity in pediatric patients is sparse. We hypothesized that patients with EPSBO required a higher rate of re-exploration, and therefore may warrant more aggressive management.
Methods:
After obtaining IRB approval, pediatric patients identified as having a small bowel obstruction within the first 6 weeks after appendectomy from July 2014–December 2018 were reviewed. Demographic and clinical data relevant to their initial operative intervention and subsequent small bowel obstruction were collected. Descriptive statistics were calculated using Microsoft Excel.
Results:
Six patients out of a total of 801 appendectomies performed during this time period were identified as having an EPSBO (0.75%), with a median age of 11.8 years. Four (66.7%) had uncomplicated appendicitis at presentation, while two (33.3%) had some evidence of complicated appendicitis on initial imaging. They all underwent laparoscopic appendectomy, five using standard Endo GIA laparoscopic staplers (Medtronic, Minneapolis, MN) and one using suture ligation, and had uncomplicated initial post-operative courses. Patients re-presented due to obstructive symptoms an average of 11 days post-operatively (range 2–37). All received cross-sectional imaging at re-presentation, though in only one patient was the staple line identified as the culprit lesion on imaging. Three of these patients underwent immediate operative intervention due to concerning findings on imaging, while three underwent initial non-operative management. Despite initial conservative management, each patient ultimately required operative intervention for EPSBO. At re-exploration, four patients were found to have a mechanical obstruction originating from staples from their appendectomy, including two with internal hernia with ischemic bowel due to adhesions from the staple line (See Figure 1). Two patients were found to have adhesive small bowel obstructions at re-exploration.
Conclusion:
EPSBO after laparoscopic appendectomy in children is rare, but may signify a mechanical issue due to the staple line. In our series all patients with EPSBO after appendectomy required operative intervention, regardless of initial conservative management. In this scenario, clinicians should consider early operative management of EPSBO after appendectomy.
