Clinical and Ultrasonographic Predictors of Surgical Intervention in Pediatric Adhesive Small Bowel Obstruction: A Retrospective Study

Background Adhesive small bowel obstruction (ASBO) is a common cause of intestinal obstruction in children and remains a diagnostic and therapeutic challenge. Early identification of patients requiring surgical intervention is essential for improving outcomes. Methods This retrospective study included 92 pediatric patients (2–17 years) diagnosed with ASBO between 2020 and 2025. Patients were divided into conservative (n = 74) and surgical (n = 18) groups. Clinical, laboratory, and ultrasonographic parameters were analyzed. Multivariate logistic regression and ROC curve analysis were performed to identify independent predictors of surgical intervention. Results Absence of peristalsis, bowel wall thickening > 3 mm, and presence of free intraperitoneal fluid were identified as independent predictors of surgical treatment (p < 0.05). The combined model demonstrated good predictive performance (AUC = 0.81). Conclusion Ultrasound is a valuable tool in the evaluation of pediatric ASBO. Specific sonographic features can help predict the need for surgical intervention and support early clinical decision-making.