Role of Gastrografin in Patients With Small Bowel Obstruction

Abstract

Introduction Gastrografin (GGF) is a radiopaque contrast medium commonly used for diagnostic examination of the gastrointestinal (GI) tract. Available evidence suggests it has therapeutic and predictive value in the management of adhesional small bowel obstruction (ASBO). Thus, we investigated the use of GGF amongst patients who had a small bowel obstruction and audited the practice in University Hospital, Ayr. Methods Initial retrospective data of patients who had gastrografin for small bowel obstruction were extracted from April 2015 to August 2019 and analysed. After our local presentation and on implementing a GGF protocol, we prospectively collected data from February to June 2020 to close our audit. Results GGF showed a comparable therapeutic effect on ASBO in both audit cycles (72.2%-66.7%). Approximately 50% of unresolved cases were operated within 24 hours of GGF administration in both cycles. GGF consistently demonstrated a therapeutic benefit in refractory faecal impaction (100% in both cycles) and postoperative ileus (≥ 80%). Early use of computed tomography (CT) (less than 24 hrs) did not confer any added advantage (82.5% v 61.5%), however, it helped in making an appropriate diagnosis and the subsequent early gastrografin usage (78.3% v 92.3%) in ASBO. Conclusion GGF serves a very good therapeutic purpose in resolving ASBO, refractory constipation, and in rare non-resolving cases of postoperative ileus. Early CT diagnosis of ASBO is advocated before the administration of gastrografin. Unsuccessful resolution after 24 hrs of GGF is an indication for operative intervention.

Evaluation of the Role of Water-Soluble Contrast Administration in Management of Patients with Adhesive Intestinal Obstruction

“…From our study, more than 81% of cases of ABO resolved with gastrogra n administration demonstrating a signi cant bene t in conservative management of ABO. This bene t is supported by evidence from randomized controlled trials that detailed further bene ts, as providing expedited resolution of obstruction, allowing earlier discharge and reducing the need for surgery in some patients [17,18].…”

Atypical Small Bowel Obstruction Caused by Perforated Cecum: A Case Report

“…In nonemergent SBOs, non-operative/conservative management is promptly initiated. Conservative management options, dependent on the patient's well-being, include fluid resuscitation, pain control, restricting oral intake, antibiotics, and NG tube placement [11,12]. The aforementioned non-operative management can resolve certain types of SBOs, the sequelae being bowel decompression.…”

“…Failed conservative management and a high pretest probability of bowel compromise (bowel ischemia, necrosis, or perforation) upon clinical or radiographic examination should bypass non-operative management and the patient be taken immediately for surgical intervention [12]. A patient with complete bowel obstruction is at increased risk of life-threatening complications due to bowel ischemia and perforation.…”

“…A complete bowel obstruction on imaging will show an absence of air or fluid in the distal small bowel past the transition point and the absence of air in the large bowel. Specific radiographic findings such as pneumo-peritoneum, bowel ischemia, or necrosis along with an unwell patient require immediate surgical intervention [12,17].…”

Role of Gastrografin in Adhesive Intestinal Obstruction

“…A retrospective study in 2020 also concluded that gastrografin has a major therapeutic role in relieving adhesive small intestinal obstruction and refractory constipation. Compared to a CT scan, it is more effective and has a higher diagnostic value (82.5% vs 92.3%) [16]. The UK national audit recommends the use of gastrografin after 48 hours of conservative treatment and operative treatment after 24 hours of gastrografin administration and no improvement [17].…”