Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis



Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction.


From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction.


Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913–0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9.


Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.

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This study was funded by the Tianjin Science and Technology Plan Project (Grant no. 14RCGFSY00150) for data collection and language polishing.

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Correspondence to Hua-Lei Cui.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the relevant guidelines and regulations approved by the Institutional Research Ethics Board of Tianjin Children’s Hospital (IRB no. L2020-29) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Feng, W., Du, XB., Zhao, XF. et al. Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis. Pediatr Surg Int (2021). https://doi.org/10.1007/s00383-021-04862-w

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  • Complicated appendicitis
  • Appendectomy
  • Adhesive bowel obstruction
  • Children