Síndrome Adherencial en Niños: Valor Predictivo de la Administración Precoz de Contraste Hidrosoluble sobre la necesidad de Cirugía

Adhesion intestinal obstruction (AIO) is an important cause of hospital admission in children unless there is suspicion of strangulation, conservative management is initially indicated. However, the optimal period for this remains controversial. The objective of this review is to evaluate the usefulness of water-soluble radiological contrast in OIA cases as a predictive factor for the need for surgery. Prospective study from January 2022 to July 2023, of patients with clinical-radiological criteria of OIA. The epidemiological data, personal history, as well as the clinical and radiological characteristics of the current condition are described. They are administered 5 to 10 cc per kg of weight of water-soluble contrast, and an abdominal x-ray is performed at 30 minutes, 60 minutes, and 120 minutes. If contrast appears in the right colon on one of the plates, fluid tolerance will begin. Otherwise, the need for surgery will be determined based on the patient's evolution and at the discretion of the surgical team. The ability of the protocol to predict the need for surgery in these patients will be analyzed, as well as the identification of any variable that is useful and effective in predicting the positivity of the test. Of the 10 patients with OIA. Surgery was indicated for 7 (70%), while fluid tolerance was effective in 3. The average length of hospital stay was 6 ± 11 days. The sensitivity, specificity, positive predictive value and negative predictive value of the absence of contrast in the right colon as an indicator of surgery was 90%. Early oral administration of water-soluble radiological contrast in pediatric patients with OIA can effectively predict the need for surgery. It allows reducing not only the hospital stay, but also the potential morbidity of late surgery generated by the prolongation of ineffective conservative treatment.