DOI: http://dx.doi.org/10.18203/2349-2902.isj20190391

Evaluation of the role of oral gastrografin in management of simple adhesive small bowel obstruction in children

Almoutaz A. Eltayeb, Nagla H. Abu-faddan

Abstract


Background: The risk of post-operative adhesive small intestinal obstruction is highest during the first post-operative year. Bowel injury during adhesiolysis increases the post-operative morbidity. Consequently, the conservative management of small bowel obstruction has considerable interest. The aim of this study was to evaluate the therapeutic role of gastrografin in the management of small bowel obstruction.

Methods: All patients with simple adhesive small bowel obstruction will be included and treated conservatively for 48hours unless there was evidence of strangulation. After the first 48hours all the patients were given oral gastrografin unless improved or signs of strangulation arise.  The evaluating parameters are the success rate, time to start full oral feeding and total duration of hospital stay.

Results: Twenty-five cases were included in which two of them developed clinical evidence of strangulation during the first 48hours and were explored. Three cases improved on the conservative treatment. The remaining twenty cases were given oral gastrografin. Fourteen cases out of twenty showed the contrast dye in their large bowel by 24hours. Those 14 cases tolerated full oral feeding earlier and had shorter hospital stay than the remaining 6 cases that declared treatment failure and underwent surgical exploration.

Conclusions: The use of gastrografin as a preliminary step of non-surgical treatment of simple adhesive intestinal obstruction may be helpful. However, further randomized study on a large number of patients was needed.

Keywords


Gastrografin and water-soluble contrast study, Simple adhesive intestinal obstruction

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References


Aguayo P, Ho B, Fraser JD, Gamis A, Peter SS, Snyder CL. Bowel obstruction after treatment of intra-abdominal tumors. Euro J Pediatr Surg. 2010;20(4):234.

El-Gohary Y, Alagtal M, Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatric Surg Inter. 2010;26(2):203-6.

Bonnard A, Kohaut J, Sieurin A, Belarbi N, El Ghoneimi A. Gastrografin for uncomplicated adhesive small bowel obstruction in children. Pediatr Surg Inter. 2011;27(12):1277-81.

Kapoor S, Jain G, Sewkani A, Sharma S, Patel K, Varshney S. Prospective evaluation of oral gastrografin in postoperative small bowel obstruction. J Surg Res. 2006;131(2):256-60.

Choi HK, Chu KW, Law WL. Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg. 2002;236(1):1.

Biondo S, Pares D, Mora L, Martí Ragué J, Kreisler E, Jaurrieta E. Randomized clinical study of Gastrografin® administration in patients with adhesive small bowel obstruction. Brit J Surg. 2003;90(5):542-6.

Choi HK, Law WL, Ho JW, Chu KW. Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation. WJG. 2005;11(24):3742.

Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD. 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.

Abbas SM, Bissett IP, Parry BR. Meta‐analysis of oral water‐soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg. 2007;94(4):404-11.

Lee CY, Hung MH, Lin LH, Chen DF. Evaluation of a water-soluble contrast agent for the conservative management of adhesive small bowel obstruction in pediatric patients. J Pediatr Surg. 2015;50(4):581-5.

Eeson GA, Wales P, Murphy JJ. Adhesive small bowel obstruction in children: should we still operate?. J Pediatr Surg. 2010;45(5):969-74.

Vijay K, Anindya C, Bhanu P, Mohan M, Rao PL. Adhesive small bowel obstruction (ASBO) in children-role of conservative management. Med J Malaysia. 2005;60(1):81-4.

Akgür FM, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Adhesive small bowel obstruction in children: the place and predictors of success for conservative treatment. J Pediatr Surg. 1991;26(1):37-41.