Successful Non-Operative Management of Adhesive Small Bowel Obstruction: Is it Really a Success?

BACKGROUND: In adhesive small bowel obstructions (ASBOs), literature has shown that passage of a water-soluble contrast challenge at either 8 hours or 24 hours is predictive of successful non-operative management (NOM) for an ASBO, but the long-term outcomes between these two groups are unknown. We hypothesized that patients who require longer transit times to the colon have a higher one-year recidivism of ASBO. METHODS: This was a 4-year review of patients with presumed ASBO undergoing successful NOM. Those requiring operation or those with an SBO due to something other than adhesions were excluded. Patients were divided into two groups (8 hour and 24 hour) based on when contrast reached their right colon. Patients were followed for one year to determine ASBO recurrence. RESULTS: 137 patients underwent NOM; 112 in the 8-hour group and 25 in the 24-hour group. One-year recurrence rate was 21.4% in the 8-hour group and 40% in the 24-hour group (P = 0.05). The median time to recurrence was 113 days in the 8-hour group and 13 days in the 24-hour group (P = 0.02). Of those who recurred in the 24-hour group, 60% recurred within 30 days (P = 0.01). On univariable analysis, first-time ASBO and 24-hour transit time were risk factors for recurrence. CONCLUSIONS: Adhesive small bowel obstruction patients undergoing NOM in the 24-hour group had a recurrence rate nearly twice that of patients in the 8-hour group and may benefit from an operative exploration during the index hospitalization at the 8-hour mark of a water-soluble contrast challenge, especially if experiencing a first-time ASBO.

Diffusion-tensor imaging derived metrics of the corpus callosum in children with neurofibromatosis type I.

OBJECTIVE: MR morphometric studies have suggested that structural brain abnormalities including corpus callosum enlargement may, in part, explain cognitive deficits in children with neurofibromatosis type 1 (NF-1). Diffusion tensor imaging (DTI) metrics of the corpus callosum in adults with NF-1 have recently been reported, but such studies in children with NF-1 are needed. The purpose of this study was to quantify the DTI metrics at 3 T of different regions of the corpus callosum in children with NF-1. SUBJECTS AND METHODS: DTI metrics from seven consecutively identified patients with NF-1 (6 boys and 1 girl; age range, 3-17 years; average age, 7.0 years) were compared with 11 age- and sex-matched control subjects (10 boys and one girl; age range, 3-17 years; average age, 7.1 years) at 3 T. Fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated in different sections of the corpus callosum as well as whole-brain mean diffusivity. RESULTS: Comparing children with NF-1 to control subjects, there were statistically significant decreases in fractional anisotropy in the genu, anterior body, and isthmus of the corpus callosum and significant increases in radial diffusivity in the genu and anterior body. Whole-brain mean diffusivity histograms revealed significant increases in whole-brain mean diffusivity in children with NF-1. CONCLUSION: Children with NF-1 have abnormal DTI metrics, particularly in the genu, and elevated whole-brain mean diffusivity. NF-1-related microstructural abnormalities of the corpus callosum are detectable in childhood and likely persist through myelination maturation.