Diagnostic and Therapeutic Role of Water Soluble Contrast in Adhesive Small Bowel Obstruction
Background: Adhesive small bowel obstruction is one of the commonly encountered clinical problems associated with repeated hospitalization. Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need of operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. Aim: To evaluate the role of Gastrografin in predicting the need of surgery in post-operative intestinal obstruction and its therapeutic effect in management of adhesive intestinal obstruction. Methods: This prospective nonrandomized controlled trial study was conducted on 72 patients with a diagnosis of adhesive small bowel obstruction. All patients were divided into Groups A and B. In 36patients of Group A, Gastrografin dye was administered and serial abdominal X-rays were taken up to 24 hours. The patients, in whom contrast reached caecum within 24 hours, the result was positive for partial obstruction and they were treated conservatively. False positive included high-grade partial obstructions that ultimately required surgery. If the contrast failed to reach the large bowel within 24 hours, the patient was considered to have complete obstruction and was operated. In 36 patients of Group B, all these patients were treated conservatively and were operated when required. Qualitative data was analysed by Fisher exact test. Results: In our study, in gastrograffin group 83.3% of cases were managed conservatively and 16.6% were operated, whereas in control group 66.6% were managed conservatively and 33.3% were operated (P value=0.02). Further in case of patients who received dye 88.9% patients resolved within 24 to 48 hours were as in case of controls only 33.3 % patients resolved within 24 to 48 hours. Therefore, in our study gastrograffin had 100% sensitivity and 86.6 % specificity, 86.6% positive predictive value and 100% negative predictive value. Overall accuracy was calculated to be 88.88%. The mean hospital stay of group A patients was 4.4 days and in case of group B was 6.3 days (p value 0.009). Conclusions: Gastrografin was effective and safe for prediction of need for surgery in adhesive small bowel obstruction. Furthermore, it speeds the resolution of obstruction and reduces the need for operation.
2. Tamphiphat C, Chicttmittrapap S, Prasopsunti K. Adhesive small bowel obstruction point a review of 321 cases in a Thai Hospital Am J Surg: 1987; 154: 283-7.
3. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186(1):1-9.
4. Tanphiphat C, Chittmittrapap S, Prasopsunti K. Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital. Am J Surg 1987; 154: 283-287.
5. Chen S.C.; chang K.J.; Lee P.H.; Wang S.M.; Chen K.M.; Lin F.Y. : Water soluble contrast study predicts The need for early surgery in adhesive small bowel obstruction; Br J Surg 1998 Dec; 85(12):1692-4
6. Richards WO, Williams LF Jr. Obstruction of the large and
small intestine. SurgClin North Am 1988;68:355-376.
7. Goldberg EP, Sheets JW, Habal MB. Peritoneal adhesions: prevention with the use of hydrophilic polymer coatings. Arch Surg 1980;115:776-780.
8. Holmdahl L, Risberg B. Adhesions: prevention and complications in general surgery. Eur J Surg 1997;163:169-174.
9. Matter I, Khalemsky L, Abrahamson J, Nash E, Sabo E, Eldar S. Does the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg 1997;163:767-772.
10. Kossi J, Salminen P, Rantala A, Laato M. Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions Br J Surg. 2003;90:1441-4
11. Onow S, Katoh T, Shibata Y, Matsuo K, Suzuki M, Chigira H. The value of contrast radiology for postoperative adhesive small bowel obstruction. Hepatogastroenterol 2002; 49: 1576-78.
12. Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 1994;115:433-437.
13. Srinivasa S, Thakore N, Abbas S, Mahmood M, Kahokehr AA, Hill AG. Impact of gastrografin in clinical practice in the management of adhesive small bowel obstruction. Can J Surg 2011;54:123-7.
14. Farid M, Fikry A, El Nakeeb A, Fouda E, Elmetwally T, Yousef M, Omar W. Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO). J Surg Res. 2010 Aug., 162 (2): 170-6.
15. Biondo S, Pares D, Mora L, Marti Rague J, Kreisler E, Jaurrieta E. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. . Br J Surg. 2003 May; 90(5): 542-6.