Role of water-soluble contrast study in adhesive small bowel obstruction: A randomized controlled study

Background : Oral Gastrografin^® has been used to differentiate partial from complete small bowel obstruction. It may also have a therapeutic effect and predict the need for early surgery in adhesive intestinal obstruction.
Aim : To assess the accuracy of Gastrografin^® contrast in predicting the necessity of operative intervention in patients with adhesive intestinal obstruction and to decide on optimum period of observation in patients with adhesive intestinal obstruction.
Materials and Methods : This prospective randomized controlled trial was performed on 32 patients with adhesive intestinal obstruction admitted in the Department of Surgery of a tertiary hospital. All patients were diagnosed with adhesive intestinal obstruction and were randomized into two groups, a Control group and a Gastrografin^® group. Patients in the control group were treated conservatively. If symptoms of strangulation developed or if the obstruction did not resolve spontaneously after 48 hours of admission, a laparotomy was performed. Patients in the Gastrografin^® group received 60 ml of Gastrografin^® mixed with 40 ml of distilled water after two hours of gastric tube aspiration following admission. Those in whom the contrast medium reached the colon in 22 hours were considered to have partial intestinal obstruction and were fed orally. Any patient who did not tolerate feeds was surgically explored for persistent obstruction. All patients in whom Gastrografin^® failed to empty into the ceacum within 22 hours of administration, were operated. Findings were analyzed by standard statistical tests. Qualitative data was analyzed by either Chi-square or Fisher Exact test. For the quantitative data, the means were compared by ANOVA-F test in the case of four groups whereas for two groups it was compared by using student′s t test.
Results : Oral Gastrografin^® contrast study is safe and can facilitate the prediction of the necessity of early operative intervention compared to a plain radiograph. Oral Gastrografin^® study was found to have an overall accuracy of 82.35% in predicting the need for operative intervention in patients with adhesive small bowel obstruction. Also it was seen that it was sufficient to study the patients for 18 hours after administration of oral Gastrografin rather than 24 hours.
Conclusion : Oral Gastrografin^® helps in the management of patients with adhesive intestinal obstruction.

Keywords
Contrast study, gastrografin study, oral gastrografin, postlaparotomy adhesions, postoperative adhesions, postoperative intestinal obstruction