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.
Keywords
Gastrografin - water-soluble contrast agents - adhesions - small bowel obstruction
- management protocol - computed tomography
