Year 2020 Vol. 28 No 2




Rostov State Medical University, Rostov-on-Don,
The Russian Federation

Bowel (intestinal) obstruction is a very common case in pediatric surgical practice. Intestinal transit disorder among children is caused by organic or functional causes of the congenital origin as well as by an acquired pathology. The degree of incidence for intestinal obstruction is steadily increasing. This is due to the increasing number of cases with congenital gastrointestinal tract malformations, as well as the increasing number and volume of surgical interventions onto the intestine.
The literature review is dedicated to the problem relevance of the bowel obstruction complicated forms treatment among pediatric patients. One of the key stages of surgical treatment is the determination of the intestinal viability involved into the lesion. The determination of viability has a matter of subjectivity if based only on the visual characteristics of the ischemia area, which can lead to an incorrect assessment of the vital properties of the organ. The current instrumental methods are technically difficult to implement and, in most cases, cannot be applied within the conditions of the emergency departments of public health care. The outcomes of surgical treatment largely depend on the development of the most effective method for determination of the local bowel necrosis, as well as the resection sites. The outstanding problem is the level involved into the creation of entero- or colostomy considering the subsequent reconstructive surgery, verification of the agangliosis area in Hirschsprung disease, which are the directions of the future research.

Keywords: intestinal obstruction, Hirschsprung disease, intussusception, necrotizing enterocolitis, intestinal viability, adhesive obstruction
p. 188-196 of the original issue
  1. Razin MP, Syrchin EF, Kuznetsov SY, Lobastov DK. Rare forms of intussusception. Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2015;5(2):79-82. (In Russ.)
  2. Grant HW, Parker MC, Wilson MS, Menzies D, Sunderland G, Thompson JN, Clark DN, Knight AD, Crowe AM, Ellis H. Adhesions after abdominal surgery in children. J Pediatr Surg. 2008 Jan;43(1):152-56; discussion 156-57.doi: 10.1016/j.jpedsurg.2007.09.038
  3. Yang YJ. The optimal timing of enterostomy closure in preterm infants. Pediatr Neonatol. 2014 Oct;55(Is 5):333-34. doi: 10.1016/j.pedneo.2014.06.001
  4. Lautz TB, Raval MV, Reynolds M, Barsness KA. Adhesive small bowel obstruction in children and adolescents: operative utilization and factors associated with bowel loss. J Am Coll Surg. 2011 May;212 (5):855-61. doi: 10.1016/j.jamcollsurg.2011.01.061
  5. Szylberg L, Marszałek A. Diagnosis of Hirschsprungs disease with particular emphasis on histopathology. A systematic review of current literature. Prz Gastroenterol. 2014;9(5):264-69. doi: 10.5114/pg.2014.46160
  6. Minaev SV, Doronin VF, Obedin AN, Timofeev SV. The peritoneal adhesions in children. Med Vestn Sever Kavkaza. 2009;(1):17-20. (In Russ.)
  7. Nasir AA, Abdur-Rahman LO, Bamigbola KT, Oyinloye AO, Abdulraheem NT, Adeniran JO. Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children? Afr J Paediatr Surg. 2013 Jul-Sep;10(3):259-64. doi: 10.4103/0189-6725.120908
  8. Ameh EA, Ayeni MA, Kache SA, Mshelbwala PM. Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease. Afr J Paediatr Surg. 2013 Oct-Dec;10(4):315-19. doi: 10.4103/0189-6725.125429
  9. Razumovskii AYu, Polunina NV, Savvina VA, Iakovleva AI, Varfolomeev AR, Nikolaev VN. Nekroticheskii enterokolit v svete izmeneniia kriteriev zhivorozhdennosti. Vopr Prakt Pediatrii. 2014;9(3):56-59. (In Russ.)
  10. Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizingenterocolitis in neonatal intensive care units. J Pediatr Surg. 2010 Jul;45(7):1391-97. doi: 10.1016/j.jpedsurg.2009.12.002
  11. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, Laptook AR, Sánchez PJ, Van Meurs KP, Wyckoff M, Das A, Hale EC, Ball MB, Newman NS, Schibler K, Poindexter BB, Kennedy KA, Cotten CM, Watterberg KL, DAngio CT, DeMauro SB, Truog WE, Devaskar U, Higgins RD. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015 Sep 8;314(10):1039-51. doi: 10.1001/jama.2015.10244
  12. Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2018 Mar;103(2):F182-89. doi: 10.1136 / archdischild-2017-313880
  13. Smolentsev MM, Razin MP. Surgical treatment of children with adhesive intestinal obstruction today. Fundam Issledovaniia. 2015;(1):1680-84. (In Russ.)
  14. Rodin AV, Pleshkov VG. Evaluation of the viability of the intestine during surgical treatment in the course of acute intestinal obstruction. Vestn SGMA. 2016;15(1):75-82. (In Russ.)
  15. Babich II. Melnicov YuN. Intraoperative diagnostics of intestines vitality under conditions of different variations of childrens intestines obstructions. Med Vestn Sever Kavkaza. 2018;13(4):615-19. doi: 10.14300/mnnc.2018.13119 (In Russ.)
  16. Solovev AE, Anikin IA, Pakholchuk AP. Treatment of necrotic enterocolitis in newborn children. Grekovs Bulletin of Surgery. 2016;175(1):71-73. doi: 10.24884/0042-4625-2016-175-1-71-73 (In Russ.)
  17. Rao SC, Basani L, Simmer K, Samnakay N, Deshpande G. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD006182. doi: 10.1002/14651858.CD006182.pub2
  18. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM , Islam S, Langer JC, Sato TT, Brandt ML, Lee H, Blakely ML, Lazar EL, Hirschl RB, Kenney BD, Hackam DJ, Zelterman D, Silverman BL. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006 May;354(21):2225-34. doi: 10.1056/NEJMoa054605
  19. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008 Jul;248(1):44-51. doi: 10.1097/SLA.0b013e318176bf81
  20. Rees CM, Eaton S, Khoo AK, Kiely EM; Members of NET Trial Group, Pierro A. Peritoneal drainage does not stabilize extremely low birth weight infants with perforated bowel: data from the NET Trial. J Pediatr Surg. 2010 Feb;45(2):324-28; discussion 328-9. doi: 10.1016/j.jpedsurg.2009.10.066
  21. Singh M, Owen A, Gull S, Morabito A, Bianchi A. Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma. J Pediatr Surg. 2006 Apr;41(4):725-29; discussion 725-9. doi: 10.1016/j.jpedsurg.2005.12.017
  22. Haro JI, Prat OJ, Albert CA, Muñoz FE, Castañón G-AM. Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy. J Pediatr Surg. 2016 Aug;51(8):1251-54.doi: 10.1016 / j. jpedsurg.2016.02.086
  23. Hamraev AJ, Karimov IM, Shamsiev AF, Saidalihodjaev B, Fayzullaev L. Tactics treatment of neonates with necrotising enterokolitis. Ros Vestn. 2014;4(1):55-57. (In Russ.)
  24. Karpova II, Parshikov VV, Batanov GB, Nikolajchuk VA. Experience with surgical treatment of newborns with necrotizing enterocolitis. Vestn Khirurgii im II Grekova. 2012;171(2):58-60. (In Russ.)
  25. Trushin PV, Sklyar KE, Kostylyova ES, Shelkovnikov DS, Tolmachyov IA. Analysis of compliance of surgical treatment techniques on necrotizing coloenteritis to process stages. Journal of Siberian Medical Sciences. 2015;(3):34. (In Russ.)
  26. Kozlov YuA, Novozhilov VA, Kovalkov , Chubko DM, Baradieva PZh, Timofeev AD, Us GP, Kusnelsova NN. New surgical strategies for treatment of necrotizing enterocolitis in neonates. Annaly Khirurgii. 2015;(5):24-30. (In Russ.)
  27. Kozlov YuA, Novozhilov VA, Weber IN, Rasputin AA, Kovalkov KA, Chubko DM, Baradieva PZ, Zvonkov DA, Timofeev AD, Ochirov CB, Rasputina NV, Us GP, Kuznetsova NN. Surgical treatment of necrotizing enterocolitis multifocal forms in premature infants clip and drop technique. Pediatriia. 2017;96(4):116-20. doi: 10.24110/0031-403X-2017-96-4-116-120 (In Russ.)
  28. Karpova IIu, Parshikov VV, Nikolaichuk VA, Batanov GB. Primenenie otsrochennogo kishechnogo anastomoza pri multisegmentarnom iazvenno-nekroticheskom porazhenii kishechnika u novorozhdennogo rebenka. Vestn Khirurgii im II Grekova. 2012;171(2):100. (In Russ.)
  29. Ron O, Davenport M, Patel S, Kiely E, Pierro A, Hall NJ, Ade-Ajayi N. Outcomes of the clip and drop technique for multifocal necrotizing enterocolitis. J Pediatr Surg. 2009 Apr;44(4):749-54. doi: 10.1016/j.jpedsurg.2008.09.031
  30. Pang KK, Chao NS, Wong BP, Leung MW, Liu KK. The clip and drop back technique in the management of multifocal necrotizing enterocolitis: a single centre experience. Eur J Pediatr Surg. 2012 Feb;22(1):85-90. doi: 10.1055/s-0031-1291287
  31. Svirsky AA, Sevkovsky IA, Averin VI, Marakhovsky KYu, Makhlin A, Valek LV, Silina EV, Anisimova EV, Ustinovich EV, Poleschuk VYu, Kachan AA. Necrotizing enterocolitis of newborns pressing issues and factors prognosticating treatment outcome. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2016;6(3):19-26. (In Russ.)
  32. Kozlov YuA, Novozhilov VA, Timofeev AD. Spontaneous perforation of the intestine in prematurely born children. Ros Vestnik Det Khirurgii Anesteziologii i Reanimatologii. 2016;6(4):102-10. (In Russ.)
  33. Hamraev AZh, Ergashev , Hamroev UA. Clinical features, diagnosis and surgical treatment of Hirschsprungs disease newborn and infants. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2013;3(4):59-62. (In Russ.)
  34. Chubarova AI, Kostomarova , Mokrushina OG, Shumikhin VS, Cherkasova SV, Tshapov NF, Dmilrieva IB, Selivarova EV, Petrova LV, Emirbekova SK, Koshko OV, Korchagina NS. Complications of diagnostics and treatment of patients with total and subtotal intestinal aganglionosis. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2016;6(2):26-37. Russ.)
  35. Akilov KhA, Saidov FKh, Khodjimuhamedova NA. Hirschsprungs disease, complications of perforation of the colon (case report). Koloproktologiia. 2014;(2):11-14. (In Russ.)
  36. Strukovsky E, Tarakanov VA, Starchenko V, Nadgeriev V, Lunyaka N, Tereschenko A, Poleev V, Palchikov V, Shatov V. Levchenko IS, Pilipenko NV. Emergency colostomy in treatment of children with illness Hirschsprung. Kuban Nauch Med Vestn. 2010;(9):137-39. (In Russ.)
  37. Ionov AL, Shcherbakova OV. Postoperative complications in colorectal surgery in children. Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2013;3(4):50-58. (In Russ.)
  38. Smirmov AN, Dronov AF, Kholostova VV, Mannanov AG, Ermolenko EYu. Intestinal stoma in children: related problems and solutions. Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2013;3(4):71-82. (In Russ.)
  39. Novozhilov VA, Kozlov YuA, Kashicyna AA, Podkamenev AV, Krasnov PA, Kononenko MI. The role of entero- and colostomy in management of congenita l gastrointestinal diseases in newborns and infants. Sib Med Zhurn (Irkutsk). 2010;94(3):112-14. (In Russ.)
  40. Arts E, Botden SM, Lacher M, Sloots P, Stanton MP, Sugarman I, Wester T, de Blaauw I. Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprungs disease. Tech Coloproctol. 2016 Oct;20(10):677-82. doi: 10.1007/s10151-016-1524-5
  41. Momynkulov AO, Tursunkulov BSh, Ruzuddinov DB, Kartalova DF, Kryuchkov VA. Contemporary diagnosis and management of intussusception children. Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2014;4(1):51-54. (In Russ.)
  42. Smolentsev MM, Razin MP, Sukhikh NK. Comparative characteristics of different methods of surgical treatment in children with adhesive intestinal obstruction. Ros Vestn Det Khirurgii Anesteziologii i Reanimatologii. 2015;5(3):20-27. (In Russ.)
  43. Barskaya MA, Varlamov AV, Zavyalkin VA, Zebrova TA, Terekhina MI, Ustinova TK. Our experience of diagnostics and treatment of intestinal intussusception in children. Sovrem Problemy Nauki i Obrazovaniia [Elektronnyi zhurnal]. 2018;(2):14. Rezhim dostupa: (In Russ.)
  44. Geraskin AV, Vrublevskiy SG, Trunov VO, Popov VE. Briling SR, Poddubny GS. Golovanev UB. Sulavko YaP. Laparoscopic treatment of adhesion intestinum illness in children. Ros Vestn Det Khirurgii, Anesteziologii i Reanimatologii. 2012;2(1):15-18 (In Russ.)
  45. Ntoulia A, Tharakan SJ, Reid JR, Mahboubi S. Failed Intussusception Reduction in Children: Correlation Between Radiologic, Surgical, and Pathologic Findings. AJR Am J Roentgenol. 2016 Aug;207(2):424-33. doi: 10.2214/AJR.15.15659
  46. Lochhead A, Jamjoom R, Ratnapalan S. Intussusception in children presenting to the emergency department. Clin Pediatr (Phila). 2013 Nov;52(11):1029-33. doi: 10.1177/0009922813506255
  47. Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, Rodriguez JR. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediator Surg. 2013 May;48(5):1032-36. doi: 10.1016/j. jpedsurg. 2013.02.021
  48. Fallon SC, Kim ES, Naik-Mathuria BJ, Nuchtern JG, Cassady CI, Rodriguez JR. Needle decompression to avoid tension pneumoperitoneum and hemodynamic compromise after pneumatic reduction of pediatric intussusception. Pediatr Radiol. 2013 Jun;43(6):662-67. doi: 10.1007/s00247-012-2604-y
  49. Tareen F, Ryan S, Avanzini S, Pena V, Mc Laughlin D, Puri P. Does the length of the history influence the outcome of pneumatic reduction of intussusception in children? Pediatr Surg Int. 2011 Jun;27(6):587-89. doi: 10.1007/s00383-010-2836-6
  50. Feigin E, Kravarusic D, Goldrat I, Steinberg R, Dlugy E, Baazov A, Zer M, Freud E. The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction. J Pediatr Surg. 2010 May;45(5):966-8. doi: 10.1016/j.jpedsurg.2010.02.025
  51. Babich II, Melnikov YuN. Treatment of severe forms of enteric emboly among infants. Sovrem Nauka: Aktualnye Problemy Teorii i Praktiki. Ser Estestvennye i Tekhnicheskie nauki. 2018;(12):117-20. (In Russ.)
Address for correspondence:
344022, Russian Federation,
Rostov-on-Don, Nakhichevansky Lane, 29,
Rostov State Medical University,
Surgical Diseases Department of the
Faculty of the Advanced Training and Staff Retraining.
Tel.: +7 950 849 27 21,
Yuri N. Melnikov
Information about the authors:
Babich Igor I., MD, Professor, Professor of the Surgical Diseases Department of the Faculty of the Advanced Training and Staff Retraining, Rostov State Medical University, Rostov-on-Don, Russian Federation.
Melnikov Yuri N., Post-Graduate Student of the Surgical Diseases Department of the Faculty of the Advanced Training and Staff Retraining, Rostov State Medical University, Rostov-on-Don, Russian Federation.
Contacts | ©Vitebsk State Medical University, 2007-2023