Compliance on the use of water-soluble contrast agent in adhesional small bowel obstruction

Abstract

Objectives: Small bowel obstruction is associated with significant morbidity and mortality. This study aimed to map outcomes of patients admitted with adhesional small bowel obstruction (ASBO ) with a view evaluating the effectiveness of water-soluble contrast agents (WSCA). Materials and Methods: A retrospective review of all emergency admissions coded for operative and non-operative treatment of small bowel obstruction between January 2018 and June 2020. Electronic patient records were utilized to confirm cases of ASBO. Patient demographics, hospital administrative data, treatment and surgery-related data are collected. Results: A total of 110 patients were admitted with ASBO initiated with conservative management. Median time to computed tomography (CT) scan was 12 h (Range: 3–115 h). Oral contrast was administered in only 11%; of these, 58% (7/12) resolved spontaneously compared to 52% (51/98) in those without contrast. About 43% (47/110) of all patients necessitated surgical intervention. Median time from admission to surgery was 43.5 h (Range: 10– 288 h). There were one 30-day re-admissions in patients surgically managed compared to two in those conservatively managed. Conclusion: Early CT scan facilitates initiation of non-operative management in stable patients with ASBO. In this series, the scant use of WSCA despite international guidelines did not compromise patient outcomes or length of stay.