Prospective evaluation of oral gastrografin in postoperative small bowel obstruction

Abstract

Postoperative small bowel obstructions occur in 6% to 30% of patients after previous laparotomy. In the absence of any evidence for a gangrenous small bowel obstruction, a trial of conservative management results in resolution of the obstruction in 70% to 80% of the cases. In this study, 62 adult patients with postoperative small bowel obstructions were managed conservatively with NG suction, correction of electrolyte imbalance, and intravenous hydration. A total of 38 patients improved within 48 hours, and 24 had failure of conservative management after 48 hours. They were given 100 mL of full-strength gastrografin through the nasogastric tube and were followed with serial radiographs and physical examinations for the next 24 hours. Patients in whom the contrast failed to reach the colon within 24 hours were considered to have a complete small bowel obstruction and were operated upon. In 22 of the 24 patients, the bowel obstruction resolved. Those patients who were considered to have a complete obstruction (absence of any colonic gas on the x-rays) were excluded as were those with peritonitis, patients with abdominal wall hernias, or patients with known inflammatory bowel disease, tuberculosis, radiation enteritis, or documented intra-abdominal malignancy. This treatment method was used only in those patients considered to have a “incomplete” small bowel obstruction who did not respond to initial conservative therapy.