The value of Gastrografin in Adhesive Small Bowel Obstruction: Prediction of need for Surgery and Therapeutic Effect
Abstract
Background: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need of operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested.
Aim: To evaluate the role of Gastrografin in predicting the need of surgery in post operative intestinal obstruction and its therapeutic effect in management of adhesive intestinal obstruction.
Material and Methods: This prospective nonrandomized controlled trial study was conducted on 30 patients with a diagnosis of adhesive small bowel obstruction. All patients were divided into Groups A and B. In 20 patients of Group A, Gastrografin dye was administered and serial abdominal X-rays were taken up to 24 hours. The patients, in whom contrast reached caecum within 24 hours, the result was positive for partial obstruction and they were treated conservatively. False positive included high-grade partial obstructions that ultimately required surgery. If the contrast failed to reach the large bowel within 24 hours, the patient was considered to have complete obstruction and was operated. In 10 patients of Group B, all these patients were treated conservatively and were operated when required. Qualitative data was analysed by Fisher exact test.
Result: The sensitivity, specificity, positive predictive value and negative predictive value of this study as an indicator for non- operative treatment were 100%, 57.14%, 81.2% and 100% . The patients who had the contrast, resolved earlier (Pvalue was 0.052) and need of surgery was lesser as compared to the control group.
Conclusion: Gastrografin was effective and safe for prediction of need for surgery in adhesive small bowel obstruction. Furthermore, it speeds the resolution of obstruction and reduces the need for operation.
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