| Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. | |
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MedLine Citation:
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PMID: 12131078 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment. SUMMARY BACKGROUND DATA: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction. METHODS: Patients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed. For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement. RESULTS: One hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group. CONCLUSIONS: The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails. |
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Authors:
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Hok-Kwok Choi; Kin-Wah Chu; Wai-Lun Law |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Annals of surgery Volume: 236 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 2002 Jul |
Date Detail:
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Created Date: 2002-07-19 Completed Date: 2002-08-21 Revised Date: 2013-06-09 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Adolescent Adult Aged Aged, 80 and over Contrast Media / administration & dosage* Diatrizoate Meglumine / administration & dosage* Female Humans Intestinal Obstruction / etiology, radiography, surgery, therapy* Intestine, Small Male Middle Aged Prospective Studies Tissue Adhesions / complications*, surgery*, therapy Treatment Failure Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 131-49-7/Diatrizoate Meglumine |
| Comments/Corrections | |
Comment In:
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Ann Surg. 2002 Jul;236(1):7-8
[PMID:
12131079
]
Gastroenterology. 2003 Mar;124(3):852-3 [PMID: 12612921 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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