title: A protocol for the management of adhesive small bowel obstruction.
abstract: BACKGROUND
  Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively.
  
  
  METHODS
  Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours. Laboratory values and a computed tomography scan of the abdomen and pelvis with intravenous contrast were obtained. Patients with peritonitis or computed tomography scan findings suggesting bowel compromise were taken to the operating room for exploration following resuscitation. All other patients received 80 mL of Gastroview (GV) and 40 mL of sterile water via nasogastric tube. Abdominal plain films were obtained at 4, 8, 12, and 24 hours. If contrast did not reach the colon within 24 hours, then operative intervention was performed.
  
  
  RESULTS
  Over 1 year, 91 patients were admitted with aSBO. Sixty-three patients received GV, of whom 51% underwent surgery. Twenty-four patients went directly to the operating room because of clinical or imaging findings suggesting bowel ischemia. Average time to surgery was within 1 day for the no-GV group and 2 days for the GV group. Patients passing GV to the colon within 5 hours of administration had a 90% rate of resolution of obstruction. There was a direct relationship between the duration of time before passing GV to the colon and hospital length of stay (HLOS) (r = 0.459). Patients who received GV and did not require surgery had lower HLOS (3 days vs. 11 days, p < 0.0001).
  
  
  CONCLUSIONS
  The GV protocol facilitated early recognition of complete obstruction. Administration of GV had diagnostic and therapeutic value and did not increase HLOS, morbidity, or mortality.
  
  
  METHODS
  Therapeutic study, level V. Epidemiologic study, level V.
authors.affiliation: From the University of Florida Health, Gainesville, Florida.
authors.forename: Tyler
authors.initials: T
authors.lastname: Loftus
authors.forename: Frederick
authors.initials: F
authors.lastname: Moore
authors.forename: Erin
authors.initials: E
authors.lastname: VanZant
authors.forename: Trina
authors.initials: T
authors.lastname: Bala
authors.forename: Scott
authors.initials: S
authors.lastname: Brakenridge
authors.forename: Chasen
authors.initials: C
authors.lastname: Croft
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.forename: Winston
authors.initials: W
authors.lastname: Richards
authors.forename: David
authors.initials: D
authors.lastname: Mozingo
authors.forename: Linda
authors.initials: L
authors.lastname: Atteberry
authors.forename: Alicia
authors.initials: A
authors.lastname: Mohr
authors.forename: Janeen
authors.initials: J
authors.lastname: Jordan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003287:Contrast Media; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D012828:Silicones; D017693:Sodium Bicarbonate; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; D012828:Silicones; C030067:gastrovision; D017693:Sodium Bicarbonate