Title: Evaluation of efficacy of gastrografin in adhesive small bowel obstruction
Authors: Dr Mukul Gupta, Dr Kalpana Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.152
Abstract
Background: Various conservative means of managing ASBO have been reported, including nasogastric tube suction and fluid resuscitation, and administration of water-soluble contrast agents, such as gastrografin, which may also serve to determine the need for surgery. In adults, conservative treatment of ASBO is frequently used and has been found to be effective in a relatively large, but somewhat variable (approximately 40% to 70%), proportion of cases.
Aim: To evaluate the effectiveness of gastrografin in adhesive small bowel obstruction.
Materials and Method: The present study was conducted in the Department of General Surgery of the medical institution. For the study we selected a total of 80 patients diagnosed for ASBO. Patients were randomized to receive Gastrografin (Group 1) or Placebo (Group 2) with 40 patients in each group. In patients with of Group 1, 60 ml of Gastrografin admixed with 40 ml of normal saline was administered after two hours of active stomach decompression through nasogastric tube. Patients of both groups were closely monitored by repeated clinical examination without further radiological examination. The criteria for discharge were patient free from obstructive symptoms and tolerating normal diet.
Results: Out of the 35 patients in Group 1, 28 patients received treatment of ASBO with conservative management with surgery required in only 7 patients. SBO was resolved within first twenty four hours of admission in 26 patients of Group 1 and 13 patients of Group 2 (p<0.05). Patients who were managed conservatively in Group A and Group B had a mean hospital stay of 5.2 + 1.2 days and 8.8 + 1.9 days respectively.
Conclusion: The administration of oral water soluble agent in cases of ASBO has a definite therapeutic role in their management.
Keywords: ASBO, gastrograffin, conservative treatment, surgical treatment.
References
- Ten Broek R, Issa Y, van Santbrink E, Bouvy N, Kruitwagen R, Jeekel J, Bakkum E, Rovers M, van Goor H. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. Br Med J. 2013;347:f5588.
- Menzies D, Ellis H. Intestinal obstruction from adhesions--how big is the problem? Ann R CollSurg Engl. 1990;72:60–63.
- Onoue S, Katoh T, Shibata Y, Matsuo K, Suzuki M, Chigira H. The value of contrast radiology for postoperative adhesive small bowel obstruction. Hepat-ogastroenterology. 2002;49:1576–1578.
- Chen SC, Lin FY, Lee PH, Yu SC, Wang SM, Chang KJ. Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg. 1998;85:1692–1694.
- Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg. 2002;236:1–6.
- Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW. The safety and duration of non-operative treatment for adhesive small bowel obstruction. Aust N Z J Surg. 1993;63:367–371.
- Choi H-K, Law W-L, Ho JW-C, Chu K-W. Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation. World Journal of Gastroen-terology : WJG. 2005;11(24):3742-3745. doi:10.3748/wjg.v11.i24.3742.
- Loftus T, Moore F, VanZant E, et al. A protocol for the management of adhesive small bowel obstruction. The journal of trauma and acute care surgery. 2015;78(1): 13-21. doi:10.1097/TA.0000000000000491.
- Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD. Water soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg. 2008 Oct;32(10):2293-304. doi: 10.1007/s00268-008-9694-6.
- Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery. 1994 Apr;115(4):433-7.