title: Failure of conservative treatment with Gastrografin® for adhesive small bowel obstruction after colorectal surgery.
abstract: OBJECTIVE
  The aim of this study was to identify risk factors related with failure of conservative management of adhesive small bowel obstruction (ASBO) in patients with previous colorectal surgery.
  
  
  METHODS
  Patients admitted with the diagnosis of ASBO after previous colorectal resection, were included. All patients underwent administration of Gastrografin®. Abdominal radiography was done after 24 h, to confirm the presence of contrast in colon (incomplete obstruction) or not (complete obstruction). Several factors were investigated to study their relationship with the failure of conservative management. Failure of conservative management was considered when emergency operation was needed to solve ASBO.
  
  
  RESULTS
  Incomplete obstruction was observed in 174 episodes (93.0%) while in 13 (7.0%) was complete. One hundred seventy-one ASBO episodes (91.4%) responded successfully to nonoperative treatment and 16 (8.6%) required emergency surgery. Five patients needed bowel resection. Results on the diagnostic test with Gastrografin® showed a sensitivity of 75%, specificity of 99%, positive predictive value 92%, and negative predictive value 98%. Age over 75 years was the only predictive factor for failure of conservative management. The median waiting time from the radiologic confirmation of complete obstruction to surgery was higher in patients requiring bowel resection when compared to those who did not need resection.
  
  
  CONCLUSIONS
  The use of Gastrografin® in ASBO after colorectal resection is a safe and useful tool for the indication of conservative management. Age over 75 years is a predictive factor for need of surgery. Surgery should be performed no later than the following 24 h of confirmed complete obstruction.
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Miquel
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain. sbn.biondo@gmail.com.|Department of General and Digestive Surgery, Bellvitge University Hospital, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. sbn.biondo@gmail.com.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Biondo
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Kreisler
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Uribe
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: Loris
authors.initials: L
authors.lastname: Trenti
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D000072700:Conservative Treatment; D003974:Diatrizoate Meglumine / Q000627:therapeutic use*; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D000267:Tissue Adhesions / Q000188:drug therapy*; D017211:Treatment Failure
chemical_list: D003974:Diatrizoate Meglumine
keywords: Adhesive small bowel obstruction; Gastrografin; Risk factors; Surgery