Utility of Enteral Contrast Protocols in Pediatric Adhesive Small Bowel Obstruction: A Prospective Multicenter...

Our objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children.

Enteral contrast-based protocols for adults with ASBO are associated with a decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited.

We conducted a prospective observational study between October 2020 and December 2022 at 9 children's hospitals that are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1 to 20 years diagnosed with ASBO who underwent a trial of nonoperative management at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was the need for surgery.

We enrolled 136 children (71% male; median age: 12 years); 84 (62%) received an enteral contrast challenge. There was no difference in the rate of operative intervention between the no-contrast (34.6%) and contrast groups (36.9%; P =0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay ( P =0.10) or rate of unplanned readmission ( P =0.14). Among the 49 children who required an operation, there was no significant difference in the time from admission to surgery or rate of small bowel resection based on prior contrast administration.

The addition of enteral contrast-based protocols for the management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.