Abstract

Rakesh Kumar Gupta, Chandra Sekhar Agrawal, Om Prakash Pathania, Rohit Prasad Yadav, Panna Lal Shah

Objective: To investigate the value of the hyperosmolar water-soluble contrast medium Gastrografin® in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Summary Background Data: Post-operative abdominal adhesions represent the main aetiological factor for intestinal obstruction. The mortality rate from intestinal obstruction has been quoted at 5 – 10% . The most effective way to reduce the morbidity and mortality caused by post-operative adhesions is, therefore, through early diagnosis and appropriate treatment. Methods: A prospective Gastrografin® study was performed in patients with small-intestine obstruction from June 2010 to June 2011. Results: Fifty-eight patients with adhesive intestinal obstruction received Gastrografin® via a nasogastric tube. Direct abdominal radiographs were taken after 4 and 8 h. Thirty-nine patients (67.2%) had Gastrografin® in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas–fluid levels. In the remaining 19 patients (32.7%), Gastrografin® was not observed in the right colon within 8 h: five of the 19 patients (26.3%) were successfully treated conservatively; 14 of the 19 patients (73.7%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conclusions: Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery