Recurrent Small Bowel Obstruction Following Contrast Challenge Versus Surgical Intervention at Index...

Long-term outcomes after contrast challenge (CC) in pediatric adhesive small bowel obstruction (ASBO) are unknown. This study assesses ASBO recurrence and need for surgical intervention within 1-year of ASBO admission.

We performed a multi-institutional prospective implementation study of a standardized CC algorithm in children (<18years) admitted with ASBO (10/2021-09/2024). Patients requiring urgent/emergent surgery were excluded. Readmission for ASBO recurrence was monitored for 1 year after index admission. Nonparametric tests were performed to compare groups.

Of the 264 patients enrolled, 262 patients (99%) were alive for 1-year follow-up; neither death was related to ASBO or CC exposure. Within 1 year, 35 patients (13%) had a recurrent ASBO; 19 (54%) were ultimately managed surgically. Recurrence was not associated with prior contrast administration (14% CC vs 12% no CC; p=0.70) or failure of non-operative (12% surgery vs 14% no surgery; p=0.55). Similarly, failure of NOM for recurrent ASBO (NOM) was not different based on CC (50% CC vs 67% no CC; p=0.39) or prior failure of NOM (73% previous failed NOM vs 45% successful NOM; p=0.14). There was no difference in recurrence based on NOM outcome in CC patients (15% successful NOM vs 11% failed NOM, p=0.51).

In the largest, prospective pediatric ASBO study, the 1-year ASBO recurrence rate was 13%, regardless of prior management strategy - neither contrast challenge nor surgery at index admission for ASBO affected ASBO recurrence or subsequent failure of NOM. Utilizing a CC for recurrent ASBO remains a valuable diagnostic tool to discern operative needs.