CC BY 4.0 · Surg J (N Y) 2018; 04(03): e123-e128
DOI: 10.1055/s-0038-1666781
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Managing Adhesive Small Bowel Obstruction with Water-Soluble Contrast Should Be Protocolized: A Retrospective Analysis

Jakob K. Köstenbauer
1   Department of Surgery, University of New South Wales, Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

08 December 2017

16 May 2018

Publication Date:
20 July 2018 (online)

Abstract

Aim Current literature emphasizes the effectiveness of computed tomography (CT) and water-soluble contrast agent, Gastrografin, in the investigation of adhesive small bowel obstruction (ASBO). As there is no management protocol for ASBO at our institution, the aim of this study was to determine the effect of imaging methods—CT, Gastrografin challenge (GC), or plain-film X-ray—on patient outcomes in a clinical setting.

Methods All 163 emergency presentations of ASBO during the study period between December 2010 and September 2012 were collected retrospectively. Cases were divided into three groups: CT with oral contrast, GC, or plain-film X-ray only. The primary outcome was time to theater.

Results Patients investigated with X-ray only were significantly less likely to require surgery (6% in plain-film X-ray vs. 35% and 20% in CT and GC, respectively; p = 0.003). In cases requiring surgery, GC was associated with a 24-hour longer time to imaging than CT (p < 0.001). The time to theater was 71:25 hours for GC versus 46:39 for CT (p = 0.039). There was no significant difference in bowel resection or complication rates.

Conclusion Patients undergoing water-soluble contrast studies were subjected to unnecessary delays in their clinical course. These delays are costly and avoidable. The development and implementation of an evidence-based protocol for the management of small bowel obstruction is strongly recommended. The lack of a protocol likely caused significant delays in Gastrografin administration, reducing its known benefits for clinical decision-making and length of stay.

 
  • References

  • 1 Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 1998; 186 (01) 1-9
  • 2 Geiger TM, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Ricciardi R. Has the use of anti-adhesion barriers affected the national rate of bowel obstruction?. Am Surg 2011; 77 (06) 773-777
  • 3 Diaz Jr JJJ, Bokhari F, Mowery NT. , et al. Guidelines for management of small bowel obstruction. J Trauma 2008; 64 (06) 1651-1664
  • 4 Maung AA, Johnson DC, Piper GL. , et al; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73 (05) (Suppl. 04) S362-S369
  • 5 Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 2010; 97 (04) 470-478
  • 6 Ceresoli M, Coccolini F, Catena F. , et al. Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg 2016; 211 (06) 1114-1125
  • 7 Fevang BT, Jensen D, Svanes K, Viste A. Early operation or conservative management of patients with small bowel obstruction?. Eur J Surg 2002; 168 (8-9): 475-481
  • 8 Zielinski MD, Eiken PW, Heller SF. , et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg 2011; 212 (06) 1068-1076
  • 9 Bickell NA, Federman AD, Aufses Jr AH. Influence of time on risk of bowel resection in complete small bowel obstruction. J Am Coll Surg 2005; 201 (06) 847-854
  • 10 Fevang BT, Fevang JM, Søreide O, Svanes K, Viste A. Delay in operative treatment among patients with small bowel obstruction. Scand J Surg 2003; 92 (02) 131-137
  • 11 Catena F, Di Saverio S, Kelly MD. , et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the world society of emergency surgery. World J Emerg Surg 2011; 6 (05) 5
  • 12 Goussous N, Eiken PW, Bannon MP, Zielinski MD. Enhancement of a small bowel obstruction model using the gastrografin® challenge test. J Gastrointest Surg 2013; 17 (01) 110-116 , discussion 116–117
  • 13 Zielinski MD, Bannon MP. Current management of small bowel obstruction. Adv Surg 2011; 45 (01) 1-29
  • 14 Santillan CS. Computed tomography of small bowel obstruction. Radiol Clin North Am 2013; 51 (01) 17-27
  • 15 Maglinte DD, Kelvin FM, Sandrasegaran K. , et al. Radiology of small bowel obstruction: contemporary approach and controversies. Abdom Imaging 2005; 30 (02) 160-178
  • 16 Kendrick ML. Partial small bowel obstruction: clinical issues and recent technical advances. Abdom Imaging 2009; 34 (03) 329-334
  • 17 Trésallet C, Lebreton N, Royer B, Leyre P, Godiris-Petit G, Menegaux F. Improving the management of acute adhesive small bowel obstruction with CT-scan and water-soluble contrast medium: a prospective study. Dis Colon Rectum 2009; 52 (11) 1869-1876
  • 18 Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg 2013; 74 (01) 181-187 , discussion 187–189
  • 19 Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 1997; 577 (577) 5-9
  • 20 Chu DI, Gainsbury ML, Howard LA, Stucchi AF, Becker JM. Early versus late adhesiolysis for adhesive-related intestinal obstruction: a nationwide analysis of inpatient outcomes. J Gastrointest Surg 2013; 17 (02) 288-297
  • 21 Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg 2006; 203 (02) 170-176
  • 22 Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg 2000; 87 (09) 1240-1247
  • 23 Williams SB, Greenspon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 2005; 48 (06) 1140-1146
  • 24 Barkan H, Webster S, Ozeran S. Factors predicting the recurrence of adhesive small-bowel obstruction. Am J Surg 1995; 170 (04) 361-365
  • 25 Jones K, Mangram AJ, Lebron RA, Nadalo L, Dunn E. Can a computed tomography scoring system predict the need for surgery in small-bowel obstruction?. Am J Surg 2007; 194 (06) 780-783 , discussion 783–784
  • 26 Schwenter F, Poletti PA, Platon A, Perneger T, Morel P, Gervaz P. Clinicoradiological score for predicting the risk of strangulated small bowel obstruction. Br J Surg 2010; 97 (07) 1119-1125
  • 27 Zielinski MD, Eiken PW, Bannon MP. , et al. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg 2010; 34 (05) 910-919