Overman Richard E, Hilu Matthew H, Gadepalli Samir H
Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
J Surg Res. 2020 Oct;254:314-317. doi: 10.1016/j.jss.2020.05.001. Epub 2020 Jun 4.
Postoperative small bowel obstruction (SBO) is an important complication of laparoscopic appendectomy in children, resulting in readmission and potential for intestinal loss. We reviewed our experience with early postoperative SBO.
A retrospective review was performed of patients undergoing an appendectomy with subsequent SBO from 2014 to 2018. Patients were excluded if a concurrent gastrointestinal procedure was done during the appendectomy, or if they had previous abdominal surgery.
Of 793 appendectomies performed at our institution during the study period, only six patients met the inclusion criteria for our chart review (7.6 SBO per 1000 appendectomies), ranging in age from 4 to 19 y. Four patients had uncomplicated appendicitis, and all underwent laparoscopic appendectomy within 24 h. Five were discharged postoperatively, with one patient remaining hospitalized for persistent ileus. Median time to representation with SBO was 7 d (range, 2-37). Three patients had indications for urgent exploration and underwent re-exploration shortly after presentation. Three patients underwent initial nonoperative management, but subsequently, all patients failed to progress and required operative exploration. Staples were found to be the culprit lesion in four of six patients, all of which notably initially presented with uncomplicated appendicitis, with two patients found to have ischemic bowel at the time of exploration.
Although rare, pediatric patients with SBO soon after laparoscopic appendectomy should be considered for early operative management, especially if the appendicitis was uncomplicated. When staples are used for appendectomy, stray staples should not be left as they can serve as a nidus for obstruction.
术后小肠梗阻（SBO）是儿童腹腔镜阑尾切除术后的一种重要并发症，可导致再次入院及肠道丢失的风险。我们回顾了我们在术后早期小肠梗阻方面的经验。
对2014年至2018年接受阑尾切除术后发生SBO的患者进行回顾性研究。如果在阑尾切除术中同时进行了胃肠道手术，或者患者既往有腹部手术史，则将其排除。
在研究期间，我们机构共进行了793例阑尾切除术，只有6例患者符合我们图表回顾的纳入标准（每1000例阑尾切除术中有7.6例SBO），年龄在4至19岁之间。4例患者患有单纯性阑尾炎，均在24小时内行腹腔镜阑尾切除术。5例患者术后出院，1例患者因持续性肠梗阻仍住院。出现SBO的中位时间为7天（范围为2至37天）。3例患者有紧急探查指征，在就诊后不久接受了再次探查。3例患者最初接受了非手术治疗，但随后所有患者病情均无进展，需要进行手术探查。在6例患者中有4例发现吻合钉是罪魁祸首，所有这些患者最初均表现为单纯性阑尾炎，其中2例在探查时发现有肠缺血。
尽管罕见，但对于腹腔镜阑尾切除术后不久发生SBO的儿科患者，应考虑早期手术治疗，尤其是阑尾炎为单纯性时。当使用吻合钉进行阑尾切除术时，不应遗留游离的吻合钉，因为它们可能成为梗阻的病灶。
