Contrast Challenge Algorithms for Adhesive Small Bowel Obstructions Are Safe in Children: A Multi-Institutional Study

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Radiology

Background:

• Adhesive small bowel obstruction (ASBO) management in children often involves nonoperative strategies.
• Predicting successful nonoperative management of ASBO in pediatric patients is challenging.
• The safety of using water-soluble contrast challenges for pediatric ASBO has not been well-established.

Purpose of the Study:

• To evaluate the safety of water-soluble contrast challenges in children with ASBO.
• To assess the utility of contrast challenges within nonoperative management algorithms for pediatric ASBO.

Main Methods:

• Retrospective review of pediatric patients with ASBO who received a contrast challenge (2012-2020) across five children's hospitals.
• Safety assessment involved comparing complication rates to a pre-defined threshold of 5%.
• Calculated sensitivity, specificity, NPV, and PPV of contrast challenges for predicting nonoperative management success.

Main Results:

• Of 82 children, 65% were successfully managed nonoperatively.
• No complications (0%) were associated with contrast administration, well below the 5% acceptable threshold.
• The contrast challenge demonstrated high reliability: sensitivity 100%, specificity 86%, NPV 100%, PPV 93% in predicting outcomes.

Conclusions:

• Water-soluble contrast challenges are safe for pediatric patients with ASBO.
• Contrast challenges possess high predictive value, aiding clinical decision-making for ASBO management in children.