A protocol for the management of adhesive small bowel obstruction

被引:45
作者
Loftus, Tyler [1 ]
Moore, Frederick [1 ]
VanZant, Erin [1 ]
Bala, Trina [1 ]
Brakenridge, Scott [1 ]
Croft, Chasen [1 ]
Lottenberg, Lawrence [1 ]
Richards, Winston [1 ]
Mozingo, David [1 ]
Atteberry, Linda [1 ]
Mohr, Alicia [1 ]
Jordan, Janeen [1 ]
机构
[1] Univ Florida Hlth, Gainesville, FL USA
关键词
Adhesive small bowel obstruction; mechanical small bowel obstruction; Gastroview; Gastrografin; adhesiolysis; ORAL GASTROGRAFIN; HELICAL CT; DIAGNOSIS; SURGERY; ADHESIOLYSIS; GUIDELINES;
D O I
10.1097/TA.0000000000000491
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: Differentiating between partial adhesive small bowel obstruction (aSBO) likely to resolve with medical management and complete obstruction requiring operative intervention remains elusive. We implemented a standardized protocol for the management of aSBO and reviewed our experience retrospectively. METHODS: Patients with symptoms of aSBO were admitted for intravenous fluid resuscitation, bowel rest, nasogastric tube decompression, and abdominal examinations every 4 hours. Laboratory values and a computed tomography scan of the abdomen and pelvis with intravenous contrast were obtained. Patients with peritonitis or computed tomography scan findings suggesting bowel compromise were taken to the operating room for exploration following resuscitation. All other patients received 80 mL of Gastroview (GV) and 40 mL of sterile water via nasogastric tube. Abdominal plain films were obtained at 4, 8, 12, and 24 hours. If contrast did not reach the colon within 24 hours, then operative intervention was performed. RESULTS: Over 1 year, 91 patients were admitted with aSBO. Sixty-three patients received GV, of whom 51% underwent surgery. Twenty-four patients went directly to the operating room because of clinical or imaging findings suggesting bowel ischemia. Average time to surgery was within 1 day for the no-GV group and 2 days for the GV group. Patients passing GV to the colon within 5 hours of administration had a 90% rate of resolution of obstruction. There was a direct relationship between the duration of time before passing GV to the colon and hospital length of stay (HLOS) (r(2) = 0.459). Patients who received GV and did not require surgery had lower HLOS (3 days vs. 11 days, p < 0.0001). CONCLUSION: The GV protocol facilitated early recognition of complete obstruction. Administration of GV had diagnostic and therapeutic value and did not increase HLOS, morbidity, or mortality. Copyright (c) 2015 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:13 / 19
页数:7
相关论文
共 32 条
[1]  
ASSALIA A, 1994, SURGERY, V115, P433
[2]  
Assalia A., 1997, Harefuah, V132, P629
[3]   Randomized clinical study of Gastrografin® administration in patients with adhesive small bowel obstruction [J].
Biondo, S ;
Parés, D ;
Mora, L ;
Ragué, JM ;
Kreisler, E ;
Jaurrieta, E .
BRITISH JOURNAL OF SURGERY, 2003, 90 (05) :542-546
[4]   Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction [J].
Branco, B. C. ;
Barmparas, G. ;
Schnueriger, B. ;
Inaba, K. ;
Chan, L. S. ;
Demetriades, D. .
BRITISH JOURNAL OF SURGERY, 2010, 97 (04) :470-478
[5]   Randomized controlled trial of Gastrografin in adhesive small bowel obstruction [J].
Burge, J ;
Abbas, SM ;
Roadley, G ;
Donald, J ;
Connolly, A ;
Bissett, IP ;
Hill, AG .
ANZ JOURNAL OF SURGERY, 2005, 75 (08) :672-674
[6]   Oral urografin in postoperative small bowel obstruction [J].
Chen, SC ;
Chang, KJ ;
Lee, PH ;
Wang, SM ;
Chen, KM ;
Lin, FY .
WORLD JOURNAL OF SURGERY, 1999, 23 (10) :1051-1054
[7]   Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment - A prospective randomized trial [J].
Choi, HK ;
Chu, KW ;
Law, WL .
ANNALS OF SURGERY, 2002, 236 (01) :1-6
[8]  
Daneshmand S, 1999, AM SURGEON, V65, P922
[9]   Water-soluble contrast medium (Gastrografin) value in adhesive small intestine obstruction (Asio): A prospective, randomized, controlled, clinical trial [J].
Di Saverio, Salomone ;
Catena, Fausto ;
Ansaloni, Luca ;
Gavioli, Margherita ;
Valentino, Massimo ;
Pinna, Antonio Daniele .
WORLD JOURNAL OF SURGERY, 2008, 32 (10) :2293-2304
[10]   Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group [J].
Di Saverio, Salomone ;
Coccolini, Federico ;
Galati, Marica ;
Smerieri, Nazareno ;
Biffl, Walter L. ;
Ansaloni, Luca ;
Tugnoli, Gregorio ;
Velmahos, George C. ;
Sartelli, Massimo ;
Bendinelli, Cino ;
Fraga, Gustavo Pereira ;
Kelly, Michael D. ;
Moore, Frederick A. ;
Mandala, Vincenzo ;
Mandala, Stefano ;
Masetti, Michele ;
Jovine, Elio ;
Pinna, Antonio D. ;
Peitzman, Andrew B. ;
Leppaniemi, Ari ;
Sugarbaker, Paul H. ;
Van Goor, Harry ;
Moore, Ernest E. ;
Jeekel, Johannes ;
Catena, Fausto .
WORLD JOURNAL OF EMERGENCY SURGERY, 2013, 8