The value of gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction

Abstract

Two cases in which serious intra-abdominal complications were masked by results of the contrast examination using Gastrografin were encountered. This caused the authors to review critically the use of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction. In a series of 41 cases in which the diagnostic problem was not solved initially by means of physical examination and plain abdominal roentgenograms, the Gastrografin examination proved reliable in 28 (68 per cent). The reliability of the examination was defined as the relative number of cases in which a correct decision could be made for or against surgical operation. It is concluded that Gastrografin is a valuable diagnostic aid in controversial cases of ileus. A "negative" result of the examination, however, would never be allowed to damp the surgeon's awareness of possible serious intra-abdominal conditions, which the contrast examination has failed to disclose and which require immediate surgical intervention.

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

“…Half of the patients were differently diagnosed with paralytic ileus, of which 2 patients had a definite mechanical obstruction, which was confirmed at reoperation. Different from the previous studies, Zer et al [21] reported that the use of Gastrografin provided a reliable diagnosis in 68.3% of controversial cases (28/41) when clinical signs and X-ray were inconclusive. …”

“…In the early studies, the terminology of ‘postoperative paralytic ileus' was often used [13,14,21]. In the 90s, the nomenclature ‘postoperative ileus' (POI) started to be used in addition to ‘paralytic ileus' [2], and both of them have been found in recent studies.…”

“…Six articles were included for a differential diagnosis of POI (table 5) [13,14,17,19,21,25]. Except for the studies by Frager et al [25] and Heinberg et al [19], other studies regarding differential diagnosis all contained substantial risks of bias.…”

“…Except for the studies by Frager et al [25] and Heinberg et al [19], other studies regarding differential diagnosis all contained substantial risks of bias. Most of them had a case-control or case-series design, and thus only had a LOE of 4 [13,14,17,21]. …”

“…Substantial differences, however, were found in diagnostic details such as timing and clinical endpoints (table 2). Radiological examinations were mainly used for differential diagnosis [13,14,17,19,21,22,23,25], and bowel motility examinations were only used for investigational purpose in the included studies [2,16]. …”