Contrast Medium Eased Small Bowel Blockages

MONTREAL — For patients with adhesive small bowel obstruction, a water-soluble contrast medium produces significantly better outcomes than conservative treatment, according to a study presented at a meeting sponsored by the International Society of Surgery.

“Gastrografin [meglumine diatrizoate] has been shown to shift fluid, dilute intestinal contents, and decrease edema in the intestinal wall, facilitating motility,” said Dr. Salomone Di Saverio of the emergency surgery unit at S. Orsola-Malpighi University Hospital in Bologna, Italy.

The reported operative rate for adhesive small bowel obstruction (ASBO) ranges from 27% to 42%, said Dr. Di Saverio. Although emergency surgery is mandatory in the case of total occlusion or when strangulation is suspected, partial occlusion is an indication for conservative treatment consisting of an NPO (nil per os) diet, nasogastric tube suction, and intravenous fluid resuscitation with the correction of electrolyte imbalance, he said in an interview.

In a multicenter, prospective study, Dr. Di Saverio compared conservative treatment to Gastrografin (GG) treatment in 76 patients with ASBO. Half of the patients were randomized to each arm of the study. The mean age of the patients was 68 years in the conservative treatment group, and 64 years in the GG group.

All patients were evaluated radiologically within 36 hours of treatment initiation. Patients in the GG group who had no evidence of GG in their bowel at 36 hours were considered to have a full obstruction and underwent emergency laparotomy, whereas patients with GG in the bowel but persistent symptoms at 36 hours were considered to have partial obstruction and were switched to conservative treatment. Patients in the conservative treatment group who had persistent obstruction at 36 hours were continued on conservative therapy for an additional 36 hours and then reevaluated.

A total of 31 patients in the GG group (82%) had resolution of their obstruction in a mean time of 6.5 hours, whereas the remaining 7 patients (18%) ultimately underwent surgery. One patient needed bowel resection for strangulation, said Dr. Di Saverio. In contrast, only 21 patients (55%) in the conservative treatment group responded to initial conservative therapy, and the remaining 17 (45%) needed surgery, including 2 patients who had bowel resections for strangulation.

The significant difference in surgery rate (18% in the GG group vs. 45% in the conservative treatment group) was mirrored in the difference in time to symptom resolution (6.5 hours vs. 43 hours, respectively), and the length of hospital stay (4.6 days vs. 7.8 days).

Complications such as bowel strangulation and resection were higher in the conservative treatment group (5% vs. 2.5%), but this difference was not significant, said Dr. Di Saverio. During a mean follow-up period of 20 months, there was no significant difference in relapse rate.

Dr. Di Saverio declared no conflict of interest with regard to Gastrografin.

Gastrografin is shown here in a patient with complete bowel obstruction.

This ultrasound of the same patient shows the resolved bowel obstruction. Photos courtesy Dr. Salomone Di Saverio

MONTREAL — For patients with adhesive small bowel obstruction, a water-soluble contrast medium produces significantly better outcomes than conservative treatment, according to a study presented at a meeting sponsored by the International Society of Surgery.

“Gastrografin [meglumine diatrizoate] has been shown to shift fluid, dilute intestinal contents, and decrease edema in the intestinal wall, facilitating motility,” said Dr. Salomone Di Saverio of the emergency surgery unit at S. Orsola-Malpighi University Hospital in Bologna, Italy.

The reported operative rate for adhesive small bowel obstruction (ASBO) ranges from 27% to 42%, said Dr. Di Saverio. Although emergency surgery is mandatory in the case of total occlusion or when strangulation is suspected, partial occlusion is an indication for conservative treatment consisting of an NPO (nil per os) diet, nasogastric tube suction, and intravenous fluid resuscitation with the correction of electrolyte imbalance, he said in an interview.

In a multicenter, prospective study, Dr. Di Saverio compared conservative treatment to Gastrografin (GG) treatment in 76 patients with ASBO. Half of the patients were randomized to each arm of the study. The mean age of the patients was 68 years in the conservative treatment group, and 64 years in the GG group.

All patients were evaluated radiologically within 36 hours of treatment initiation. Patients in the GG group who had no evidence of GG in their bowel at 36 hours were considered to have a full obstruction and underwent emergency laparotomy, whereas patients with GG in the bowel but persistent symptoms at 36 hours were considered to have partial obstruction and were switched to conservative treatment. Patients in the conservative treatment group who had persistent obstruction at 36 hours were continued on conservative therapy for an additional 36 hours and then reevaluated.

A total of 31 patients in the GG group (82%) had resolution of their obstruction in a mean time of 6.5 hours, whereas the remaining 7 patients (18%) ultimately underwent surgery. One patient needed bowel resection for strangulation, said Dr. Di Saverio. In contrast, only 21 patients (55%) in the conservative treatment group responded to initial conservative therapy, and the remaining 17 (45%) needed surgery, including 2 patients who had bowel resections for strangulation.

The significant difference in surgery rate (18% in the GG group vs. 45% in the conservative treatment group) was mirrored in the difference in time to symptom resolution (6.5 hours vs. 43 hours, respectively), and the length of hospital stay (4.6 days vs. 7.8 days).

Complications such as bowel strangulation and resection were higher in the conservative treatment group (5% vs. 2.5%), but this difference was not significant, said Dr. Di Saverio. During a mean follow-up period of 20 months, there was no significant difference in relapse rate.

Dr. Di Saverio declared no conflict of interest with regard to Gastrografin.

Gastrografin is shown here in a patient with complete bowel obstruction.

This ultrasound of the same patient shows the resolved bowel obstruction. Photos courtesy Dr. Salomone Di Saverio

MONTREAL — For patients with adhesive small bowel obstruction, a water-soluble contrast medium produces significantly better outcomes than conservative treatment, according to a study presented at a meeting sponsored by the International Society of Surgery.

“Gastrografin [meglumine diatrizoate] has been shown to shift fluid, dilute intestinal contents, and decrease edema in the intestinal wall, facilitating motility,” said Dr. Salomone Di Saverio of the emergency surgery unit at S. Orsola-Malpighi University Hospital in Bologna, Italy.

The reported operative rate for adhesive small bowel obstruction (ASBO) ranges from 27% to 42%, said Dr. Di Saverio. Although emergency surgery is mandatory in the case of total occlusion or when strangulation is suspected, partial occlusion is an indication for conservative treatment consisting of an NPO (nil per os) diet, nasogastric tube suction, and intravenous fluid resuscitation with the correction of electrolyte imbalance, he said in an interview.

In a multicenter, prospective study, Dr. Di Saverio compared conservative treatment to Gastrografin (GG) treatment in 76 patients with ASBO. Half of the patients were randomized to each arm of the study. The mean age of the patients was 68 years in the conservative treatment group, and 64 years in the GG group.

All patients were evaluated radiologically within 36 hours of treatment initiation. Patients in the GG group who had no evidence of GG in their bowel at 36 hours were considered to have a full obstruction and underwent emergency laparotomy, whereas patients with GG in the bowel but persistent symptoms at 36 hours were considered to have partial obstruction and were switched to conservative treatment. Patients in the conservative treatment group who had persistent obstruction at 36 hours were continued on conservative therapy for an additional 36 hours and then reevaluated.

A total of 31 patients in the GG group (82%) had resolution of their obstruction in a mean time of 6.5 hours, whereas the remaining 7 patients (18%) ultimately underwent surgery. One patient needed bowel resection for strangulation, said Dr. Di Saverio. In contrast, only 21 patients (55%) in the conservative treatment group responded to initial conservative therapy, and the remaining 17 (45%) needed surgery, including 2 patients who had bowel resections for strangulation.

The significant difference in surgery rate (18% in the GG group vs. 45% in the conservative treatment group) was mirrored in the difference in time to symptom resolution (6.5 hours vs. 43 hours, respectively), and the length of hospital stay (4.6 days vs. 7.8 days).

Complications such as bowel strangulation and resection were higher in the conservative treatment group (5% vs. 2.5%), but this difference was not significant, said Dr. Di Saverio. During a mean follow-up period of 20 months, there was no significant difference in relapse rate.

Dr. Di Saverio declared no conflict of interest with regard to Gastrografin.

Gastrografin is shown here in a patient with complete bowel obstruction.

This ultrasound of the same patient shows the resolved bowel obstruction. Photos courtesy Dr. Salomone Di Saverio