Nate Rubocava
25 statements · 1 topic
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There were no major or minor complications in the study, and with a 0% complication rate and a confidence interval of 0 to 3.6%, this was significantly below our pre-set acceptable complication rate of 5%.
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Aspiration
Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery.
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Aspiration
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Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery.
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Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery.
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Traditional treatment of adhesive small bowel obstruction has been gastric decompression, bowel rest, fluid resuscitation, and electrolyte replacement.
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Over the last two decades, the use of water-soluble contrast agents in the management of small bowel obstructions has become well established in the adult literature, given their ability to predict the success of non-operative management.
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A contrast challenge is performed when a patient presents with a small bowel obstruction that qualifies for non-operative management. After a period of gastric decompression, the patient is given the contrast and will wait a period of 8 to 10 hours after which an abdominal X-ray is obtained.
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Contrast in the colon is considered having passed their contrast challenge, and after the patient demonstrates clinical improvement with tolerance of a regular diet, they are discharged from the hospital.
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For those who still don't have contrast in their colon after a repeat abdominal X-ray at 24 hours, they're considered to have failed their contrast challenge and will be taken to surgery for exploration.
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Limited data exists with regards to safety and use of a contrast challenge in the pediatric population, yet multiple pediatric institutions have adopted contrast challenge algorithms.
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The study performed a retrospective review of all children undergoing a contrast challenge across 5 children's hospitals over a period of 8 years.
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By group consensus, a complication rate less than 5% would be considered safe to use a contrast challenge for clinical practice.
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Major complications were defined as aspiration, pneumonia, anaphylaxis, cardiovascular complications, and renal failure. Minor complications included urticaria, dyspnea, and worsening abdominal pain.
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The group that failed their contrast challenge had a significantly longer hospital stay by 5 days.
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Overall, 82 children underwent a contrast challenge. 57 initially passed their challenge, of which 53 had clinical improvement and were successfully discharged. There were 25 who failed and were taken to surgery. The 4 that failed to completely resolve were also taken to surgery.
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A total of 6 patients were readmitted within 30 days for a recurrent small bowel obstruction.
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There was a significant age difference between the two groups, with those passing the challenge between a median of 7 years older.
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The cohort included patients affected with neurologic and pulmonary comorbidities which were present in over 30% of patients.
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The contrast challenge has a sensitivity of 100%, specificity of 86%, negative and positive predictive values of 100% and 93% respectively for predicting successful non-operative management.
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The contrast agents used were institution-specific, all had relatively similar osmodality, with dilute gastrographin being the most commonly utilized agent.
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This review of 82 patients is the largest to date in children demonstrating that a contrast challenge is safe, effective, and highly predictive in children.
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There were no major or minor complications in the study, and with a 0% complication rate and a confidence interval of 0 to 3.6%, this was significantly below our pre-set acceptable complication rate of 5%.
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There were no major or minor complications in the study, and with a 0% complication rate and a confidence interval of 0 to 3.6%, this was significantly below the pre-set acceptable complication rate of 5%.
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Every institution had a similar protocol that had been mirrored to Doctor Grace Mack from University of Chicago's study from 2018.
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The Midwest Pediatric Surgery Consortium is doing a prospective study looking at contrast challenges in pediatric adhesive small bowel obstruction.
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More pediatric surgeons are now saying the study showed it was safe and effective in being able to predict which child will successfully be managed with non-operative management.
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