A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstruction.
BACKGROUND
The purpose of this prospective study was to determine the value of water-soluble contrast follow-through radiology in predicting the outcome in patients with small bowel obstruction.


METHODS
Patients with clinical and radiological evidence of small bowel obstruction were selected according to pre-set criteria. A water-soluble contrast follow-through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as 'significant obstruction' if the contrast failed to reach the caecum in 4 h or if there was a clear cut-off in the gastrointestinal tract. The result was interpreted as 'insignificant obstruction' if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the contrast examination in the patient management, and the decision to operate was based entirely on conventional clinical grounds.


RESULTS
Fifty-one patients in an 18 month period underwent the contrast examinations. Thirty-four patients (67%) had previous abdominal operations. The results showed that significantly more patients who had 'significant obstruction' on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had "insignificant obstruction' (1/32; Fisher's exact test, P < 0.0001). This difference was found to be significant in both patient subgroups: patients with or without previous abdominal operation. There was no major morbidity or mortality related to the contrast radiology procedure.


CONCLUSIONS
Urografin follow-through examination is a safe procedure; using 4 h as the cut-off it is highly predictive of the outcome in small bowel obstruction in patients with or without previous abdominal operation.
Chung
C C
CC
Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
Meng
W C
WC
Yu
S C
SC
Leung
K L
KL
Lau
W Y
WY
Li
A K
AK
D000005:Abdomen / Q000601:surgery; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D003657:Decision Making; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D005544:Forecasting; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000601:surgery; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D016037:Single-Blind Method; D012995:Solubility; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D014867:Water
D003287:Contrast Media; D014867:Water; D003974:Diatrizoate Meglumine