Prospective analysis of the management of small bowel obstruction using oral contrast agent at tertiary care hospital in western Rajasthan

Abstract

INTRODUCTIONIntestinal obstruction is a frequently seen entity in the Emergency Department that represents 25% of abdominal pain consultations. 1 The most frequent causes of intestinal obstruction are postoperative adhesions followed by neoplasms and hernias.2 The estimated rate of adhesions is around 94%-95% after laparotomy. It has recently been demonstrated that this rate is much lower in laparoscopic procedures, although the exact percentage is not known.3 Before the 1990s, the mortality rate associated with intestinal obstruction was 30%-50%, depending on the series. 4 Nowadays, the correct diagnosis of symptoms and adequate treatment can lower the mortality rate to 3%-5%. 4-6During the management of intestinal obstruction, the patient should initially be made to fast and intravenous therapy should be administered, in addition to intestinal decompression with a nasogastric tube. Most of the symptoms will respond to conservative treatment. The indication for surgery is clear when there are data to suspect ischemia or intestinal suffering: fever, tachycardia, abdominal pain, peritonitis and acidosis. The problem lies in knowing how much time should pass before we decide whether the patient is responding to ABSTRACT Background: Intestinal obstruction is a frequently seen entity in the Emergency Department that represents 25% of abdominal pain consultations. Methods: This prospective, randomized, and clinical trial study was designed to determine the value of gastrografin in adhesive small bowel obstruction. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of gastrografin. A total of 100 patients were randomized into two groups: the control group received conventional treatment, whereas the study group received in addition of 100 ml gastrografin meal. Patients were followed up within 4 days after admission, and clinical and radiological (if needed) improvements were evaluated. Results: Surgical procedure was performed in 10% of the gastrografin group for whom conservative treatment failed at the end of fourth day. In contrast, surgery was required in 28% of control group. These findings shows that gastrografin decreased the need for surgical management by 18%, but no statistically significant differences were observed. The length of hospital stay revealed a significant reduction from 4.60±1.14 days to 2.64±1.05 days for control and gastrografin groups, respectively. Conclusions: The use of gastrografin in adhesive small bowel obstruction is safe and reduces the length of hospital stay.

Role of Gastrografin in Adhesive Intestinal Obstruction

“…Recently, the use of gastrografin has been considered in the management of adhesive intestinal obstruction for diagnostic and therapeutic purposes. Gastrografin has an osmolarity of 1900mOsm/L which is six times the osmolarity of the blood, allowing shifting of fluid from the intracellular compartment to the bowel lumen increasing pressure on the obstructive site [13]. It also makes the contents of the bowel dilute and decreases bowel wall edema, favoring the relief of obstruction and increasing intestinal motility [14].…”