Role of orally administered Gastrografin in small bowel obstruction after unsuccessful conservative treatment

Objectives: Orally administered gastrografin is a hyperosmolar water soluble contrast medium. It is commonly used for the diagnosis of small bowel obstruction but it also has a therapeutic role in small bowel obstruction (SBO). The purpose of this study was to determine the diagnostic and therapeutic role of gastrografin in cases of small bowel obstruction who didn't respond to conservative treatment. Methodology: This retrospective study was carried out from Jan 2004 to Oct 2009, in which 110 patients with diagnosis (clinical & radiological) SBO were included. An initial trial of conservative treatment was given after excluding the bowel ischemia. Every patient was observed for twenty four hours to assess the response to conservative treatment. After 24hours non-responding patients were given 100 ml of gastrografin through Ryle's tube and transit of contrast was followed by repeated abdominal radiographs taken at 4,8,12 and 24 hours after administration of gastrografin. In partially obstructed patients in whom contrast appeared in large bowel no further intervention was performed. Laparotomy was performed in remaining patients in whom gastrografin failed to reach the large bowel within 24 hours. Results: From Jan 2004 to Oct 2009, 110 patients (men = 62 & women = 48) with small bowel obstruction were included in the study. The mean age of our patients was 34.1 years (15 - 40 years). In 22% (25) patients had bowel strangulation and they were operated soon after admission. Non operative treatment was continued in 10% (12) of patients who responded to the conservative treatment in first 24hrs. Twenty eight (25%) patients had history of single surgery while 10 (9%) of patients had history of more than one operation in the past. Gastrografin was given to 73 patients who didn't respond to conservative treatment in 24hrs. Thirty four percent (25 out of 73) patients were operated for complete obstruction after gastrografin administeration. Forty five (61%) patients had partial obstruction after gastrografin administration and complete resolution of obstruction occurred in all of them except three patients who were operated for persistent obstruction. We found 92% reduction in the operative rate after gastrografin administration. No complications were noted with the use of gastrografin. Conclusion: After unsuccessful routine conservative treatment gastrografin can be used safely and it can reduce the operative rate. In this study out of 73 patients who were administered gastrographin, obstruction was completely resolved in 42 patients (57.5%). It also helps in predicting the need for surgery thus it shortens not only hospital stay but also reduces the potential morbidity of late surgery due to prolong & unsuccessful non operative treatment.