A Prospective Study on the Gastrografin Contrast Radiology in the Management of Small Bowel Obstruction

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