MANAGEMENT OF ADHESIVE SMALL BOWEL OBSTRUCTION IN CHILDREN: A WATER-SOLUBLE CONTRAST PROTOCOL AND LAPAROSCOPIC ADHESIOLYSIS

Resume. Aim: to evaluate conservative management with a water-soluble contrast test and laparoscopic adhesiolysis for adhesive small bowel obstruction in children within a prognosis-based algorithm. Methods: children with the adhesive form in a main group treated by the algorithm were compared with a control group; a contrast test of up to 24 hours guided conservative treatment, and failure prompted laparoscopic adhesiolysis. Results: adhesive obstruction accounted for 37.3 % of cases overall and became the leading cause from the age of four years. Conservative treatment succeeded in 84.0 % of main-group children versus 62.1 % of controls, and recovery without surgery rose from 46.2 % to 70.0 % (p = 0.048); when conservative treatment failed, the time to surgery shortened from 25.6 to 12.4 hours. Conclusion: a structured contrast test with early laparoscopy increases non-operative recovery and shortens delay to surgery in pediatric adhesive obstruction. Keywords: adhesive small bowel obstruction, children, water-soluble contrast, laparoscopic adhesiolysis, conservative treatment.