Randomized clinical study of Gastrografin® administration in patients with adhesive small bowel obstruction

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Abstract
Background Oral Gastrografin® has been used to differentiate partial from complete small bowel obstruction (SBO). It may have a therapeutic effect and predict the need for early surgery in adhesive SBO. The aim of this study was to determine whether contrast examination in the management of SBO allows an early oral intake and reduces hospital stay. Methods Eighty-three patients admitted between February 2000 and November 2001 with 90 episodes of symptoms and signs suggestive of postoperative adhesive SBO were randomized into two groups, a control group and Gastrografin® group. Patients in the control group were treated conservatively. If symptoms of strangulation developed or the obstruction did not resolve spontaneously after 4–5 days, a laparotomy was performed. Patients in the Gastrografin® group received 100 ml Gastrografin®. Those in whom the contrast medium reached the colon in 24 h were considered to have partial SBO, and were fed orally. If Gastrografin® failed to reach the colon and the patient did not improve in the following 24 h a laparotomy was performed. Results Conservative treatment was successful in 77 episodes (85·6 per cent) and 13 (14·4 per cent) required operation. Among patients treated conservatively, hospital stay was shorter in the Gastrografin® group (P < 0·001). All patients in whom contrast medium reached the colon tolerated an early oral diet. Gastrografin® did not reduce the need for operation (P = 1·000). No patient died in either group. Conclusion Oral Gastrografin® helps in the management of patients with adhesive SBO and allows a shorter hospital stay.