Contrast Radiography in Small Bowel Obstruction: A Prospective, Randomized Trial

Abstract

Small bowel obstruction is a common cause of acute abdominal distress, accounting for up to 20% of emergency admissions to surgical services. Although the majority of obstructions will resolve with conservative therapy alone, there are currently no reliable tests for identifying the patients who will require operation. Barium contrast studies have the potential to rapidly identify patients with complete small bowel obstruction, but many surgeons are hesitant to use them for fear of inducing complications. We report the results of a randomized, prospective trial comparing immediate oral barium contrast studies with plain abdominal X-rays in patients presenting with signs and symptoms of small bowel obstruction. End points included time to resolution of the symptoms or operation, total number of hospital days, and morbidity. Sixty-four patients completed the study; of these, 23 received contrast studies and 41 had plain radiographs only. Six of the contrast group (26%) and 11 of the plain radiograph group (27%) ultimately went to operation. Barium contrast studies had a sensitivity of 100% for diagnosing complete obstruction, whereas the sensitivity of serial plain radiographs was only 82%. Among those going to operation, the time from admission to operation was 8.2 hours in the contrast group and 12.4 hours in the plain radiograph group, but this result did not reach statistical significance (p = 0.25). Total hospital days were similar between the two groups (8 vs. 12 days, p = 0.40). There were no complications resulting from the oral administration of barium. Small bowel contrast studies using barium are safe and may shorten the time to operation in patients presenting with signs and symptoms of small bowel obstruction.

Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction

“…After review of full‐length manuscripts, 20 studies were found to be potentially eligible. Of these, six were subsequently excluded: two randomized patients to either Gastrografin ® (Schering, Berlin, Germany) or Omnipaque ™ 22, 23, one used barium as the contrast agent24, one randomized patients to either Gastrografin ® or surgery25 and two were duplicate studies26, 27. Seven studies were included in the evaluation of the diagnostic role of WSCA3–9 and nine in the assessment of its therapeutic role7, 8, 10–16.…”

Different Degrees of Small Bowel Involvement in Peritoneal Carcinomatosis may Predict the Completeness of Cytoreduction Score. Is there a Role for Staging Laparoscopy?

“…An enteroclysis study is a modification of the small bowel follow through in which the duodenum is first intubated under fluoroscopy and contrast injected under pressure. This study is highly reliable for both cases, of low and high-grade obstruction because it bypasses the stomach where washout of contrast can occur [13][14][15][16]. Although modern CT technology has significantly contributed to the determination of the PC score, it is a relatively static technology, unable to accurately observe the bowel movement and dynamic distribution of the small intestine.…”

Intestinal Obstruction and Perforation – The Role of the Surgeon

“…Most common findings are dilated small intestine loops, colonic distention, multiple air-fluid levels, and foreign bodies or gallstones. In more complicated cases, further diagnostic evaluations may be necessary [10,11].…”