WOFAPS 2025 8th World Congress of Pediatric Surgery

Emine Burcu Çığşar Kuzu ¹, Yusuf Alper Kara ², Bade Toker Kurtmen ¹, Gökhan Köylüoğlu ¹

¹ Department of Pediatric Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
² Izmir City Hospital Pediatric Surgery Clinic

Introduction
Pediatric pseudo-intestinal obstruction (PIPO) is a rare disorder marked by impaired intestinal motility due to dysfunction of gastrointestinal muscles and nerves. Patients typically present with abdominal pain, distension, and constipation lasting longer than six months without mechanical obstruction. Due to the absence of definitive diagnostic criteria and variable clinical manifestations, many undergo multiple surgeries before diagnosis. The role of surgery in pediatric PIPO remains controversial due to associated morbidity and mortality.

Methods
We retrospectively reviewed records of patients diagnosed with PIPO and followed between January 2024 and June 2025. Demographic data, clinical history, physical exam findings, and surgical details were collected for patients who underwent surgical intervention.

Results
Data from four PIPO patients who underwent multiple surgeries were analyzed. Mean patient age was 14.2 years (range: 11–18), and mean symptom onset age was 9.2 years (range: 1–14). Before referral, patients had a mean of 5 surgeries (range: 4–6), totaling 20 operations. All had a confirmed genetic diagnosis. Initial indications were suspected appendicitis in three patients and volvulus in one. Common indications for reoperation were adhesiolysis ± bowel resection and ileostomy. Two patients were referred for intestinal transplantation, and two to our intestinal rehabilitation unit. During follow-up, patients underwent an average of 1.7 (range: 1–2) surgeries. A resorbable sodium hyaluronate-based adhesion barrier gel was used in all procedures. Indications included ileostomy revision (n=2) and incisional hernia repair (n=1). No significant adhesions or related complications were noted during subsequent operations.

Conclusion

Given the high risk of postoperative adhesions in children with PIPO, surgical intervention should be avoided whenever possible. When surgery is necessary, the use of adhesion barrier gels may play a critical role in reducing postoperative morbidity.