Evaluation of a series of patients operated for adhesive intestinal obstructions

Background: The risk of bowel obstruction after laparotomy in infants and children, especially in developing countries, has not been well researched. Objectives: The aim of this study was to perform a detailed analysis of adhesions and the risk factors for adhesion-associated intestinal obstruction after laparotomy in children. Methods: This retrospective study involved patients who were operated between January 1990 and January 2001 on for postoperative adhesive intestinal obstruction (AIO). Results: During a 11-year period, a total of 45 patients aged 6 days to 14 years (mean 7.75 years) were operated on after 1341 laparotomies. The incidence of AIO was 3.35%. Six (13.3%) patients were urgently operated on while 29 (64.4%) patients were operated on in the first 3 days. The patients were operated on at 6th postoperative day at the earliest and at 10 years at the latest. Each of two children with midgut volvulus (relative risk 50%) and jejunal atresia (relative risk 27.7%) were operated on twice. The mortality and morbidity rates were found to be 2.2% (1 patient) and 22.2%, respectively. AIO was most commonly observed after operations involving the pelvic area (77.7%). Appendectomy, trauma, invagination, and megacolon surgeries were the most common postoperative causes of AIO. Conclusion: This study showed that adhesions in children occurred more commonly after lower abdominal surgery. The risks were closely related to the site and type of the first surgery. Although the risk of having adhesions was very high in the first years, it also persists in the following years.