title: Bowel obstruction without history of laparotomy: Clinical analysis of 70 patients.
abstract: BACKGROUND
  Determining the cause of bowel obstruction without a history of laparotomy (BO without HL) is difficult and can result in delay of treatment and development of a potentially life-threatening situation. We herein investigated the clinical characteristics of pediatric patients who underwent laparotomy due to BO without HL.
  
  
  METHODS
  All surgical pediatric patients aged <16 age who were diagnosed with BO without HL between January 2004 and September 2014 were included. Etiology of BO, intraoperative findings and postoperative outcome were investigated retrospectively.
  
  
  RESULTS
  Seventy patients were diagnosed with BO without HL in this period. In these 70 patients, malrotation (n = 34), intussusception (n = 19), internal hernia (n = 6) and Meckel's diverticulum (n = 5) were predominantly identified. Regarding preoperative definitive diagnosis, prevalence of internal hernia, Meckel's diverticulum or idiopathic volvulus was significantly lower than that of malrotation or intussusception (P < 0.05). Intraoperatively, the rates of strangulation and bowel resection were 55.7% and 30.0%, respectively. The optimal time for emergency operation in order to avoid strangulated bowel resection was <19 h from onset of symptoms.
  
  
  CONCLUSIONS
  Malrotation and intussusception are major causes of BO without HL in children, but internal hernia, Meckel's diverticulum and idiopathic volvulus should always be taken into account, particularly because of the preoperative diagnostic difficulty and resulting high rate of intestinal resection. In order to avoid resection of the bowel, surgery should be done within 19 h before bowel ischemic change occurs.
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yoshimaru
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Genshiro
authors.initials: G
authors.lastname: Esumi
authors.affiliation: Department of Pediatric Surgery, Japan Community Health care Organization Kyushu Hospital, Kitakyushu, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Wada
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yanagi
authors.affiliation: Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hayashida
authors.affiliation: Department of Pediatric Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ieiri
authors.affiliation: Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D002648:Child; D002675:Child, Preschool; D004065:Digestive System Abnormalities / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D045822:Intestinal Volvulus / Q000150:complications* / Q000175:diagnosis; D007443:Intussusception / Q000150:complications* / Q000175:diagnosis; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: bowel obstruction; bowel resection; history of laparotomy; primary ileus; strangulation