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[Adhesive small bowel obstruction after surgery during infancy; a potentially fatal long term complication]

Fenne A I M van den Bunder1,2, Dirk-Jan van Zuidam3, Esther Edelenbos4

  • 1Amsterdam UMC, Amsterdam. Afd. Kinderchirurgie (Emma Kinderziekenhuis).

Nederlands Tijdschrift Voor Geneeskunde
|September 24, 2023
PubMed

Insights

A rare fatal complication of pyloromyotomy, a surgery for infantile hypertrophic pyloric stenosis, is presented. This case highlights adhesive small bowel obstruction (ASBO) as a potential long-term risk following the procedure.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Pathology

Background:

  • Pyloromyotomy is a common surgical procedure for infantile hypertrophic pyloric stenosis.
  • It is generally considered safe with a low complication rate and rapid recovery.
  • This report details an exceptionally rare and fatal complication.

Observation:

  • A 12-year-old boy with a history of pyloromyotomy presented with severe abdominal pain and vomiting.
  • He collapsed and required cardiopulmonary resuscitation, later dying in the hospital.
  • Autopsy revealed two perforations and an adhesive small bowel obstruction (ASBO) originating from the pyloromyotomy scar.

Findings:

  • The autopsy identified extensive adhesions causing small bowel obstruction at the site of the previous pyloromyotomy scar.
  • Fecal matter was present in the abdominal cavity, indicating bowel perforation.
  • The patient had a history of recurrent abdominal pain since age six, undiagnosed.

Implications:

  • Persistent abdominal pain in children with prior abdominal surgery warrants thorough investigation for adhesions.
  • Adhesive small bowel obstruction (ASBO) can be a delayed and severe complication of pyloromyotomy.
  • Diagnostic laparoscopy should be considered for persistent, unexplained abdominal pain in this patient population.
Abstract

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