Role of Gastrografin in assigning patients to a non-operative course in adhesive small bowel obstruction.

BACKGROUND: Adhesive small bowel obstruction (SBO) is a common surgical emergency. Water soluble contrast agents have been used to identify patients who might be treated non-operatively rather than operatively. The present study was designed to audit the introduction of such use of Gastrografin contrast into clinical practice.
METHOD: Patients presenting acutely to hospital with clinically suspected and radiologically proven SBO were entered in the study. As soon as practicable, 100 mL of undiluted Gastrografin was given either orally or by the nasogastric tube (which was then spigotted). After 4 h, a plain supine abdominal X-ray (AXR) was taken. If the contrast was seen in the large bowel, and there had been no deterioration in the patient's condition, then non-operative treatment was continued. If the contrast remained in the small bowel, a clinical judgement was made as to whether to proceed with operative intervention. A group of historical controls were obtained by a retrospective review of the hospital medical records through data obtained from the Department of General Surgery Audit System.
RESULTS: Twenty-five patients were entered into the study. In 20 of these patients the contrast was seen to arrive in the large bowel at 4 h. All of these patients completed a non-operative course to full recovery. In another two patients a successful decision was made to pursue a non-operative management strategy. These 22 patients had a mean hospital stay of 3.9 days. Eighty historical controls had successfully completed a non-operative course for SBO. They had a mean hospital stay of 5.6 days. This was significantly longer than that of the Gastrografin group (P < 0.016, t-test).
CONCLUSION: This paper has demonstrated that undiluted Gastrografin may be safely used to assign patients to a non-operative management plan and this results in a decreased hospital stay.