title: Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin.
abstract: BACKGROUND
  Gastrografin represents a useful tool in the diagnosis and management of adhesive small bowel obstruction (ASBO). The aim of this study is to identify variables with negative influence in nonoperative management with gastrografin.
  
  
  METHODS
  From August 2008 to March 2013, 223 consecutive patients with 235 episodes of ASBO were included and received gastrografin. A protocol for prospective data collection was developed. In order to explore factors related to the failure of nonoperative treatment, univariate and multivariate analysis were performed.
  
  
  RESULTS
  One hundred and ninety eight episodes responded to nonoperative treatment (84.2% of success) and 33 patients (15.8%) required surgical intervention. Only 3 patients of the gastrografin cohort with contrast in colon, required surgery. Predictive factors of failure of nonoperative management with gastrografin were patients aged above 65 (p = 0.01; OR 1.791, 95% CI 1.41-2.19), with a history of 2 or more previous laparotomies (p = 0.03; OR 2.91, 95% CI 2.19-3.71), and who had undergone previous abdominal surgery due to ASBO (p = 0.002; OR 1.381, 95% CI 1.10-1.79).
  
  
  CONCLUSIONS
  Patient age, the number of previous laparotomies, and the fact that previous abdominal surgery was conducted due to ASBO are indicative of unsuccessful management with gastrografin.
authors.affiliation: Department of Digestive Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Bueno-Lledó
authors.forename: Sebastian
authors.initials: S
authors.lastname: Barber
authors.forename: Javier
authors.initials: J
authors.lastname: Vaqué
authors.forename: Mateo
authors.initials: M
authors.lastname: Frasson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Granero
authors.forename: Manuel
authors.initials: M
authors.lastname: Juan-Burgueño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine