Clinical Impacts of Oral Gastrografin Follow-Through in Adhesive Small Bowel Obstruction (SBO)

Background. Many studies have shown that gastrografin can be used for diagnosis of adhesive small bowel obstruction (ASBO) and for assessing the need for surgical intervention. However, several studies have reported conflicting results. Therefore, the aim of this study is to assess the diagnostic and therapeutic effect of gastrografin in ASBO. Patients and Methods. Altogether, 110 patients with ASBO were randomized into control and gastrografin groups. In the gastrografin group, 100 mL of the dye was administered through a nasogastric tube. Obstruction was considered complete if the contrast failed to reach the colon on the 24-h film. Patients with gastrografin in the colon within 24 h after dye administration were considered as partially obstructed, and were submitted to nonoperative treatment. The patients were operated on if they developed signs of strangulation or failed to improve within 48 h. Results. The overall operative rate was 14.5% in gastrografin group versus 34.5% in control group, P = 0.04. The time from admission to resolution of symptoms was significantly lower in gastrografin group (19.5 versus 42.6 h, P = 0.001), and the length of hospital stay was shorter in gastrografin group (3.8 versus 6.9 d 0.002), and in nonoperative patients (3.1 versus 5.1 days). Sensitivity, specificity, positive predictive value, and negative predictive value for gastrografin follow-through as an indicator for operative treatment of ASBO were 87.5%, 100%, 100 %, and 97.9%, respectively. Conclusions. Oral gastrografin helps in the management of ASBO. Oral gastrografin is safe and reduces the operative rate and time of resolution as well as hospital stay. (C) 2010 Elsevier Inc. All rights reserved.