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Published on: March 5, 2018
Strangulated small bowel obstruction in children
Yi-Jung Chang1, Dah-Chin Yan1, Jin-Yao Lai2
1Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
Insights
Diagnosing intestinal strangulation in children with small bowel obstruction (SBO) is challenging. A clinical score combining symptoms and imaging findings accurately predicts strangulated SBO.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Diagnosing intestinal strangulation as a complication of small bowel obstruction (SBO) presents a significant challenge in pediatric patients.
- Early and accurate diagnosis is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate clinicoradiological parameters for predicting intestinal strangulation in children with SBO.
- To develop a diagnostic scoring system for identifying strangulated SBO.
Main Methods:
- Retrospective review of medical records for 69 pediatric patients undergoing surgery for acute SBO.
- Regression analysis to identify predictive parameters for strangulated SBO.
Main Results:
- Intestinal strangulation was present in 27 of 69 patients.
- A clinical score was developed based on intractable continuous abdominal pain, tachycardia, elevated white blood cell count (>13,600/mm³), and abdominal distention.
- A score of ≥2, combined with ultrasound findings of ascites or CT scan findings of thickened bowel walls with reduced contrast enhancement, indicated strangulation.
Conclusions:
- The combination of clinical parameters (pain, tachycardia, leukocytosis, distention) and imaging findings (ascites on US, or wall thickening/reduced enhancement on CT) is effective in identifying strangulated SBO in children.
- This approach aids in the early diagnosis and management of this critical condition.
Background:
Diagnosing intestinal strangulation as a complication of small bowel obstruction (SBO) remains a considerable challenge in children. We evaluated the clinicoradiological parameters for predicting the presence of a strangulated intestine.
Methods:
We reviewed the medical records of 69 pediatric patients who underwent operation for acute SBO. Regression analysis was used to identify the parameters for predicting strangulated SBO.
Results:
Of the 69 patients with SBO, 27 patients had intestinal strangulation and were awarded one point each towards the overall clinical score: intractable continuous abdominal pain, tachycardia, white blood cell count >13,600/mm3, and abdominal distention. Patients with a clinical score ≥2 combined with the presence of ascites in ultrasound (US) results or with wall thickness and reduced wall contrast enhancement in abdominal computed tomography (CT) scans showed strong evidence for intestinal strangulation.
Conclusion:
The combination of two or more clinical parameters, including intractable continuous abdominal pain, tachycardia, leukocytosis, and abdominal distention with the presence of ascites in US or wall thickness and reduced wall contrast enhancement in, is useful for the identification of strangulated SBO.
The Type Of Study And Level Of Evidence:
Prognosis study; Level III.
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