Incidence and treatment of adhesive bowel obstruction after gastroschisis closure

Abstract

Background: Children with gastroschisis, especially when it is complicated by atresia or perforation, often suffer from severe long-term sequelae such as short-bowel syndrome and chronic dysmotility. These children are also susceptible to adhesive bowel obstruction later in life, which can alter their nutritional intake and may require repeated visits to the hospital. However, few long-term studies have attempted to determine the rate of occurrence of intestinal occlusion after gastroschisis. In this study we measured the incidence and management of
adhesive bowel obstruction in children with gastroschisis at one academic pediatric hospital.

Methods: A retrospective chart review was carried out on patients with gastroschisis born between January 2000 and December 2007. A total of 74 patients who underwent closure of their gastroschisis during this period were identified.

Results: Twelve of these 74 (16%) patients were readmitted to the hospital with at least one episode of adhesive bowel obstruction. Three of the 12 patients had gastroschisis complicated by atresia. Eight patients underwent immediate primary closure of their defect on the first day of life. Silos were installed on the remaining four (36%) and were kept in place for an average of 6.25 (range: 4–9) days. Five of the 12 children resolved their obstruction with nasogastric tube decompression alone. The remaining seven (58%) required lysis of adhesions after failure of decompression. The seven children who underwent surgical lysis of adhesions did not have additional episodes of occlusion after laparotomy.

Conclusion: In this study, 16% of the patients born with gastroschisis within a 7-year period presented with a adhesive obstruction. Occurrence of obstruction was unrelated to the method of closure or the severity of the defect. Although conservative management with nasogastric tube decompression may be effective initially, over half of patients with occlusion will need eventual surgery for lysis of adhesions.

Keywords: bowel obstruction, gastroschisis, lysis of adhesions