Prospective evaluation of oral gastrografin in postoperative small bowel obstruction.
BACKGROUND
Orally administered gastrografin has been used for early resolution of postoperative small bowel obstruction (POSBO) and to reduce the need for surgery in various studies. However the studies have reported conflicting results as patients with complete obstruction and equivocal diagnosis of bowel strangulation were also included.


METHODS
We carried out a prospective study to evaluate the efficacy of gastrografin in patients with partial adhesive small bowel obstruction. Patients with suspected strangulation, complete obstruction, obstructed hernia, bowel malignancy, and radiation enteritis were excluded. Sixty-two patients with partial adhesive small bowel obstruction were given an initial trial of conservative management of 48 h. Thirty-eight patients improved within 48 h and the other 24 were given 100 ml of undiluted gastrografin through the nasogastric tube. In 22 patients the contrast reached the colon within 24 h. In the remaining two patients the contrast failed to reach the colon and these underwent surgery.


RESULTS
The use of gastrografin avoided surgical intervention in 91.3% (22 of 24) patients who failed conservative management of POSBO. Gastrografin also decreased the overall requirement for surgical management of POSBO from the reported rate of 25 to 30% to 3.2% (2 of 62).


CONCLUSIONS
Use of gastrografin in patients with partial POSBO helps in resolution of symptoms and avoids the need for surgical management in the majority of patients.
Kapoor
Sorabh
S
Department of Surgical Gastroenterology, Bhopal Memorial Hospital and Research Centre, Bhopal, India. sorabhkapoor@hotmail.com
Jain
Gaurav
G
Sewkani
Ajit
A
Sharma
Sandesh
S
Patel
Kailash
K
Varshney
Subodh
S
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003974:Diatrizoate Meglumine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D003974:Diatrizoate Meglumine