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Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 84-87

Absolute benefit of gastrografin in adhesive small bowel obstruction: A retrospective study and review of the literature

Department of General Surgery, Kuala Krai Hospital, Kuala Krai 18000 Kelantan, Malaysia

Correspondence Address:
Asri Che Jusoh
Department of General Surgery, Kuala Krai Hospital, Kuala Krai 18000 Kelantan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2320-3846.147026

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Introduction: Adhesive small bowel obstruction (ASBO) is a major cause of postoperative morbidity. The objectives of the study are to evaluate the diagnostic and therapeutic properties of gastrografin (GF) in ASBO. Materials and Methods: A retrospective review of all adult patients admitted from January 2011 to January 2013 with ASBO, who undergone GF test was done. Apart from establishing its diagnostic property, therapeutic effects following the test were also determined such as reduced need for surgery and shortened the hospital stay. An undiluted GF (100 ml) was given once the patient is adequately rehydrated followed by supine abdominal X-ray 4-6 h later. If the contrast is seen in the colon, the test is considered as positive. Otherwise, a repeat X-ray is done 20 h later (24 h postGF). A positive test patient was considered as partially obstructed and selected for nonoperative management. Otherwise, if remain negative at 24 h surgery is considered. Results and Analyses: A total of 21 patients who fulfilled the criteria was analyzed. Majority were male (16 patients, 76.2%), aged between 14 and 84 years (mean 45.3). A total hospital stay was 5 days (median) with only 3 days for successful GF test. Eight patients (38.1%) developed first ASBO following open appendectomy whereas 28.5% (six patients) after colorectal surgery. Previous midline laparotomy was the most common approach seen (57.1%, 12 patients) followed by lanz incision (23.8%, five patients). A positive test was only demonstrated in 66.7%, 38.1% (eight patients), and 28.6% (six patients) at 4 h and 24 h, respectively. Surgery was required in seven patients (33.3%) with only one patient can be approached laparoscopically. We had no adhesion-related bowel gangrene or mortality. Conclusion: Our analysis demonstrated that GF test is safe and very beneficial in managing ASBO. It reduces the need for surgery and shortens hospital stay even in high adhesion risk group.

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