Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Contrast Challenge Algorithms for Adhesive Small Bowel Obstructions Are Safe in Children: A Multi-Institutional Study. Ann Surg 2023 Apr 01;277(4):e925-e932

Date

08/22/2021

Pubmed ID

34417363

DOI

10.1097/SLA.0000000000005159

Scopus ID

2-s2.0-85149841658 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

OBJECTIVE: The purpose of this study was to evaluate the safety of a water-soluble contrast challenge as part of a nonoperative management algorithm in children with an adhesive small bowel obstruction (ASBO).

BACKGROUND: Predicting which children will successfully resolve their ASBO with non-operative management at the time of admission remains difficult. Additionally, the safety of a water-soluble contrast challenge for children with ASBO has not been established in the literature.

METHODS: A retrospective review was performed of patients who underwent non-operative management for an ASBO and received a contrast challenge across 5 children's hospitals between 2012 and 2020. Safety was assessed by comparing the complication rate associated with a contrast challenge against a pre-specified maximum acceptable level of 5%. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of a contrast challenge to identify successful nonoperative management were calculated.

RESULTS: Of 82 children who received a contrast challenge, 65% were successfully managed nonoperatively. The most common surgical indications were failure of the contrast challenge or failure to progress after initially passing the contrast challenge. There were no complications related to contrast administration (0%; 95% confidence interval: 0-3.6%, P = 0.03). The contrast challenge was highly reliable in determining which patients would require surgery and which could be successfully managed non-operatively (sensitivity 100%, specificity 86%, NPV 100%, PPV 93%).

CONCLUSION: A contrast challenge is safe in children with ASBO and has a high predictive value to assist in clinical decision-making.

Author List

Rubalcava NS, Bence CM, Jensen AR, Minneci PC, Van Arendonk KJ, Mak G, Rymeski BA, Kohler JE, Beyene T, Lim IIP, Hirschl RB, Speck KE

Author

Christina Bence MD Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Algorithms
Child
Contrast Media
Humans
Intestinal Obstruction
Retrospective Studies
Tissue Adhesions
Treatment Outcome
Water