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DOI: 10.1055/s-0030-1253401
© Georg Thieme Verlag KG Stuttgart · New York
Bowel Obstruction after Treatment of Intra-Abdominal Tumors
Publikationsverlauf
received February 9, 2010
accepted after revision March 1, 2010
Publikationsdatum:
21. Mai 2010 (online)
![](https://www.thieme-connect.de/media/ejps/201004/lookinside/thumbnails/10.1055-s-0030-1253401-1.jpg)
Abstract
Background: Tumors of the solid viscera are one of the most common types of pediatric malignancies. Due to the intra-abdominal location of many of these neoplasms, laparotomy and/or bowel resection are often necessary, predisposing patients to postoperative intestinal obstruction. Additionally, chemotherapy and radiation therapy may lead to acute and chronic bowel injury, also potentially predisposing these patients to postoperative bowel obstruction. We reviewed our data over an eleven-year period to identify the incidence of obstruction as well as factors associated with its development.
Methods: A retrospective data analysis of all patients diagnosed with intra-abdominal Wilms’ tumor, rhabdomyosarcoma, neuroblastoma, and Hodgkin's and non-Hodgkin's lymphoma in a single institution from 1997 to 2007 was conducted. Data collected included demographic factors, operations, incidence of small bowel obstruction (SBO) and the use of adjuvant or neoadjuvant chemoradiation therapy. Patients who developed SBO were compared to those who did not develop obstruction. Data comparisons were analyzed statistically using Fisher's exact test, 2-tailed Student's t-Test, or chi-square proportional analysis with significance reported for p<0.05.
Results: A total of 291 patients were identified during the study period. Mean age at diagnosis was 8.1±5.8 years. Males accounted for 57% of all patients. Tumor distribution was as follows: Wilms’ tumor: 56 (19%); non-Hodgkin's lymphoma: 71 (24%); Hodgkin's lymphoma: 64 (22%); rhabdomyosarcoma: 32 (11%); and neuroblastoma: 68 (24%). There were a total of 12 bowel obstructions in 11 patients (3.7%). Mean follow-up for all patients was 3.6±2.7 years. Children with bowel obstruction were more likely to be male (4.5:1, p=0.061) and younger (4.2 years versus 8.1 years; p=0.087). Wilms’ tumor accounted for 45% of patients with bowel obstruction, but made up only 19% of the study population. The incidence of bowel obstruction in patients with Wilms’ tumor was 8.9% compared to an overall incidence of 3.8% (p=0.043).
Conclusion: Bowel obstruction is relatively uncommon after intra-abdominal malignancies in children. Wilms’ tumor, rhabdomyosarcoma and Burkitt's lymphoma appear to be associated with the highest risk of bowel obstruction.
Key words
bowel obstruction - malignancy - adhesions
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Correspondence
Charles L. SnyderMD
Children's Mercy Hosptial
Department of Surgery
24th and Gillham Rd
64108 Kansas City
United States
Telefon: +1 816 234 35706
Fax: +1 913 983 6371
eMail: csnyder@cmh.edu