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

Nathan S Rubalcava1, Christina M Bence2, Amanda R Jensen3

  • 1Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI.

Annals of Surgery
|August 21, 2021
PubMed

Insights

A water-soluble contrast challenge is safe for children with adhesive small bowel obstruction (ASBO). This diagnostic tool accurately predicts which patients will require surgery, aiding clinical decisions in nonoperative management.

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.
Abstract

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