title: Use of gastrografin in the management of worm-induced small bowel obstruction in children.
abstract: OBJECTIVE
  Ascaris-induced small bowel obstruction (SBO) is a common sequel of Ascaris lumbricoides (AL) infestation. Most cases respond to conservative treatment practiced in different centers worldwide. We conceived a prospective randomized trial to compare the conservative treatment with gastrografin administered in addition to the conservative treatment.
  
  
  METHODS
  This prospective randomized study was conducted between January 2011 and June 2014 at Department of Paediatric and Neonatal Surgery, a tertiary-care hospital. Patients were divided into two groups, one group received conservative treatment and the other received gastrografin in addition to conservative treatment. Forty patients having uncomplicated AL-induced SBO were included in each group. Gastrografin was administered through nasogastric tube and serial clinical and radiological monitoring was performed. The duration of hospital stay, time between admission and first oral feed, passage of worms/flatus were compared in the two groups. Student's t test was used for comparing these variables.
  
  
  RESULTS
  Average time for passage of flatus or worms and resolution of abdominal signs and was shorter in gastrografin group as compared to the conservative group. This difference was found to be statistically significant. The average duration of hospital stay in gastrografin group was 25.20 ± 8.01 h whereas it was 61.12 ± 14.64 h in the conservative group (P < 0.001). The difference in the operation rate was statistically insignificant (2 in gastrografin group and 3 in the conservative group).No serious adverse reaction was noted after gastrografin administration.
  
  
  CONCLUSIONS
  Use of gastrografin resulted in faster relief of signs and symptoms of AL-induced SBO, early passage of worms/flatus and return to oral feeds. However, the role of gastrografin role in reducing the likelihood of laparotomy remains inconclusive. Adverse effects of gastrografin can be prevented if it is used in well-hydrated patients.
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. drraashidhamid@gmail.com.
authors.forename: Raashid
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. nisarabuhadee@gmail.com.
authors.forename: Nisar
authors.initials: N
authors.lastname: Bhat
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. dr_aejaz@yahoo.co.in.
authors.forename: Aejaz
authors.initials: A
authors.lastname: Baba
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. gowharmufti@yahoo.co.in.
authors.forename: Gowhar
authors.initials: G
authors.lastname: Mufti
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. skkhursheed@yahoo.co.in.
authors.forename: Sheikh
authors.initials: S
authors.lastname: Khursheed
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. wanisajad786@gmail.com.
authors.forename: Sajad A
authors.initials: SA
authors.lastname: Wani
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India. drimranali50@yahoo.com.
authors.forename: Imran
authors.initials: I
authors.lastname: Ali
authors.affiliation: Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India.
authors.forename: Faheem
authors.initials: F
authors.lastname: Hassan
mesh_terms: D000818:Animals; D001196:Ascariasis / Q000150:complications* / Q000188:drug therapy*; D001200:Ascaris; D002648:Child; D003287:Contrast Media / Q000627:therapeutic use; D003974:Diatrizoate Meglumine / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006801:Humans; D007194:India; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000469:parasitology*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000469:parasitology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine
keywords: Ascaris lumbricoides (AL); Gastrografin (Sodium Amidotrizoate 100 mg/mL, Meglumine Amidotrizoate) 660 mg/mL; Nasogastric tube (NGT); Small bowel obstruction (SBO)