A 13- year-old boy with history of staged closure of gastroschisis as an infant presents with abdominal distention, bilious vomiting, and abdominal pain. Abdominal Xray is shown below. A representative image of the CT is shown below. It is interpreted as small bowel obstruction (SBO). Which of the following is a clinical or radiologic finding that would be a contraindication to contrast challenge in this patient?

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[size=20px]A High grade bowel obstruction

 

B Closed loop bowel obstruction

 

C SBO three years ago requiring adhesiolysis

 

D SBO 6 months ago managed by contrast challenge

 

E Bilious vomiting​[/size]

B

B Closed loop bowel obstruction

correct answer

B Closed loop bowel obstruction

 

Small bowel contrast challenge is a combined diagnostic and therapeutic intervention to evaluate and potentially treat adhesive small bowel obstruction. It is utilized when there are clinical or imaging features that support small bowel obstruction secondary for adhesions. If the obstruction is due to a mass, volvulus, hernia or is in a closed loop configuration, a contrast challenge should not be used.

 

Other contraindications include suspicion for bowel ischemia (e.g., signs of sepsis, presence of pneumatosis) or perforation.

 

Previous adhesiolysis or successful use of contrast challenge is not a contraindication for contrast challenge. Bilious vomiting can be seen with any SBO. High grade SBO can be managed initially with contrast challenge.

 

There is wide variability in the management of adhesive SBO exists across US PHIS-participating hospitals.1,2 A review of the current management of adhesive SBO in children is outlined in the Advances in Pediatrics.3 An ongoing multi-institutional study through the Midwest Pediatric Surgical Consortium (MWPSC) aims to provide dosing standards and establish best practices for children with an ASBO.