Details
Category: Volume 06 Issue 02 February 2018
Hits: 1373

Title: Role of Water Soluble Contrast in Management of Post- Operative Adhesive Small Bowel Obstruction

Authors: Dr Ashutosh Silodia M.S., Dr Chandan Tiwari M.S., Dr Anurag Dubey M.S.

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.66

Abstract

This study “Role of water soluble contrast in management of post-operative small bowel obstruction” was conducted in Department of surgery N.S.C.B. medical college between August 2013 to October 2014 to assess the therapeutic role of water soluble contrast in post operative adhesion induced small bowel obstruction in relieving obstruction. Total of 17 patients were included in study in age group 30-50yrs with majority of males. These patients were having main complaints of abdominal pain, distention vomiting, not passing flatus and motion. During diagnostic tests X-ray abdomen showed multiple bowel loops and air fluid levels.13 patients were given gastrograffin and continued in conservative management however 4 were referred for surgery. In majority of patients (46%) Ryle’s tube aspiration stopped within 24 hrs and bowel sound reappeared in first 2 days of admission (76%) on giving gastrograffin. Also 65% passed flatus and motion within 24 hrs however mean hospital stay was 8.85 days in gastrograffin treated patients compared to 16.5 days in surgically treated patients. Thus by result of this study it can be emphasised that Gastrograffin which is used as contrast media for CT scan purpose as diagnostic support can also be tried as therapeutic agent in patients with small bowel obstruction due to post-operative adhesions and have significant outcome both clinically and also statistically. Hence it can be recommended that with a specific selection criteria for patients and high range of vigilance and suspicion Gastrograffin can be used therapeutically and safely in patients of small bowel obstruction specifically due to post op adhesions to get relief from obstruction and with an advantage that if it fails then CT scan can use this dose as contrast for imaging and confirm obstruction and can be proceeded for surgery as per need.

References

  1. Weibel MA, Majno G. Peritoneal adhesions and their relation to abdominal surgery: a post-mortem study. Am J Surg 1973;126:345-353.
  2. Menzies D, Ellis H. Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 1990;72:60-63.
  3. Parikh JA, KoCY, Maggard MA, Zingmond DS. What is the rate of small bowel obstruction after colectomy? Am Surg 2008;74:1001-1005.
  4. Barkan H, Webster S, Ozeran S. Factors predicting the recurrence of adhesive small bowel obstruction .Am J Surg 1995 ;170:361-365.
  5. Miller G, Boman J, Shrier I. Natural history of patients with small bowel obstruction. Br J Surg 2000:87;1240-1247.
  6. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF. Risk factors for adverse adverse outcomes following surgery for small bowel obstruction, Ann Surg 2006;243:456-464.
  7. Miller G, Boman J, ShrierI, Gordon PH .Readmission for small bowel obstruction in the early postoperative period: etiology and outcome. Can J Surg 2002;45:255-258.
  8. Gutt CN, Oniu T, Schemner P. Fewer adhesions induced by laproscopic surgery? Surg Endosc 2004:18;898-906.
  9. Komatsu I ,Tokuda Y ,Shimada G ,Jacobs JL .Onodera H. Development of a simple model for predicting need for surgery in patient who initially undergo conservative management for adhesive small bowel obstruction. Am J Surg 2010;:200;215-223.
  10. Lappas JC, Reyes BL, Maglinte DD. Abdominal radiography findings in small bowel obstruction: relevance to triage for additional diagnostic imaging. A J R 2001;176:167-174.
  11. Joyce WP .Delany PV, Gorey TF, Fitzpatrick JM. The value of water soluble contrast study in managent of small bowel obstruction. Ann R Coll Surg Engl 1992; 74:422-5.
  12. Assalia A, Schein M, Kopelman D, Hirschberg A, Hashmonai M.T herapeutic effect of oral gastrograffin in adhesive, partial small bowel obstruction .a prospective randomized trial. Surgery 1994;115:433-437.
  13. Chung CC, Meng WC, Yu S, Leung KL, Lau WY, Li AK .A Prospective study on the use of water soluble contrast follow through radiology in the management of small bowel obstruction. ANZ J Surg 1996;66:598-601.
  14. Chen sc, Lin FY, Lee PH ,Yu SC ,Wang SM ,Chang KJ. Water soluble contrast study predicts the need for the early surgery I,n adhesive small bowel obstruction.Br J Surg 1998;85:1692-1694.
  15. Maglinte DD, Reyes BL, Harmon BH, Kelvin FM ,Turner Jr, WW Hage JE et al. Reliability and role of plain film radiography and CT in the diagnosis of small bowel obstruction. Am J Roentgenol 1996;176:1451-1455.

Corresponding Author

Dr Chandan Tiwari

Contact: + 91-8085201097, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.