Conservative treatment of adhesive small bowel obstruction in children: a systematic review

OBJECTIVE To assess the effectiveness of conservative treatment for adhesive small bowel obstruction (ASBO) in children. DESIGN Systematic review of studies involved children with ASBO who received initial conservative/non-operative treatment. SETTING The search was performed in April 2013 using PubMed (see online supplementary file 1), current contents, and the Cochrane database. PARTICIPANTS Children with ASBO. INTERVENTIONS Conservative treatment included nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance. PRIMARY OUTCOME Treatment success. SECONDARY OUTCOMES Length of hospital stay and the time to first feeding after hospital admission. RESULTS 7 studies (six retrospective, one prospective), involving 8-109 patients (age: 1 month to 16 years) treated conservatively, were included in the review. The nature of conservative treatment was generally consistent between studies (nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance), although patients in one study also received Gastrografin. The rate of conservative treatment success ranged from 16% to 75% among the five studies, but one trial showed 0% successful rate. The hospital length of stay ranged from 3 to 6.5 days for conservative treatment (vs 10.2-13 days for operative treatment). The time to first feeding ranged from 31 to 84 h for conservative treatment. CONCLUSIONS In conclusion, in the majority of cases, conservative treatment is an effective means of managing ASBO in children.