title: Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction.
abstract: BACKGROUND
  The optimal period of conservative treatment for adhesive small bowel obstruction remains controversial. This study sought to determine whether a 24-h abdominal radiograph after oral Urografin is a reliable indicator for operation in patients with adhesive small bowel obstruction.
  
  
  METHODS
  One hundred and sixty-one patients who suffered from adhesive intestinal obstruction without clinical evidence of strangulation or gangrene underwent a Urografin study. Some 40 ml Urografin mixed with 40 ml distilled water was administered either orally or via a nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 8, 16 and 24 h later. If an earlier plain radiograph showed that contrast medium had reached the ascending colon, subsequent radiographs were not taken.
  
  
  RESULTS
  Contrast medium reached the colon within 24 h in 112 patients (70 per cent). These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the first 24 h in 49 patients (30 per cent). Operation was performed in 47 of these patients and non-operative treatment was given in two. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Urografin reaching the colon within 24 h as an indicator for non-operative treatment were 98, 100, 99, 100 and 96 per cent respectively.
  
  
  CONCLUSIONS
  All patients with evidence of Urografin reaching the colon within 24 h were treated successfully with non-operative methods. The results of this prospective study suggest that patients with adhesive intestinal obstruction in whom contrast medium fails to reach the colon within 24 h should receive prompt surgical intervention.
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
authors.forename: S C
authors.initials: SC
authors.lastname: Chen
authors.forename: F Y
authors.initials: FY
authors.lastname: Lin
authors.forename: P H
authors.initials: PH
authors.lastname: Lee
authors.forename: S C
authors.initials: SC
authors.lastname: Yu
authors.forename: S M
authors.initials: SM
authors.lastname: Wang
authors.forename: K J
authors.initials: KJ
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D013997:Time Factors; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine