Prospective analysis of the management of small bowel obstruction using oral contrast agent at tertiary care hospital in western Rajasthan

Ashok Kumar, Rajendra Prasad, Diwan Singh Jakhar, Dharmveer Jajra, Sanjeev Kumar Chhabra, Ashish Rai


Background: Intestinal obstruction is a frequently seen entity in the Emergency Department that represents 25% of abdominal pain consultations.

Methods: This prospective, randomized, and clinical trial study was designed to determine the value of gastrografin in adhesive small bowel obstruction. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of gastrografin. A total of 100 patients were randomized into two groups: the control group received conventional treatment, whereas the study group received in addition of 100 ml gastrografin meal. Patients were followed up within 4 days after admission, and clinical and radiological (if needed) improvements were evaluated.

Results: Surgical procedure was performed in 10% of the gastrografin group for whom conservative treatment failed at the end of fourth day. In contrast, surgery was required in 28% of control group. These findings shows that gastrografin decreased the need for surgical management by 18%, but no statistically significant differences were observed. The length of hospital stay revealed a significant reduction from 4.60±1.14 days to 2.64±1.05 days for control and gastrografin groups, respectively.

Conclusions: The use of gastrografin in adhesive small bowel obstruction is safe and reduces the length of hospital stay.


Abdominal surgery, Adhesion, Small bowel obstruction

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Cooper JM, Thirlby RC. Small bowel obstruction. Curr Treat Options Gastroenterol. 2002;5:3-8.

Zhang Y, Gao Y, Ma Q, Dang C, Wei W, De Antoni F, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucaminediatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis. 2006;38:188-94.

Pickleman J. Small bowel obstruction. In: Zinner MJ, editor. Maingot’s abdominal operations. 10. London: Prentice-Hall; 1997: 1159-72.

Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl. 1993;75:147-53.

Seror D, Feigin E, Szold A, Allweis TM, Carmon M, Nissan S, et al. How conservatively can postoperative small bowel obstruction be treated? Am J Surg. 1993;165:121-6.

Matter I, Khalemsky L, Abrahamson J, Nash E, Sabo E, Eldar S. Does the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg. 1997;163:767-72.

Di Saverio S, Catena F, Ansaloni L, Gavioli M. Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg. 2008;32(10):2293-304.

Farid M, Fikry A, El Nakeeb A. Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO). J Surg Res. 2010;162(2):170-6.

Biondo S, Pares D, Mora L, Marti Rague J, Kreisler E, Jaurrieta E. Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg. 2003;90:542-6.

Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery. 1994;115:433-7.

Feigin E, Seror D, Szold A, Carmon M, Allweis TM, Nissan A. Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial. Am J Surg. 1996;171:227-9.

Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl. 1997;577:5-9.

Stordahl A, Laerum F, Gjolberg T, Enge I. Water-soluble contrast media in radiography of small bowel obstruction. Comparison of ionic and non-ionic contrast media. Acta Radiol. 1988;29:53-6.

Assalia A, Schein M.Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery. 1997;10:133-6.

McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S. Current spectrum of intestinal obstruction.Br J Surg, 1987;74:976-80.

Sosa J, Gardner B. Management of patients diagnosed as acute intestinal obstructions secondary to adhesions Am Surg. 1993;63:367-71.

Choi HK, Law WL, Ho JW, Chu KW. Value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation. World J Gastroenterol. 2005;11:3742-5.

Mucha P. Jr. Small intestinal obstruction Surg Clin North Am. 1987;67:597-620.

Bamparas G, Branco BC, Schüriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg, 2010;14:1619-28.