SP9.1.4 Management of Small Bowel Obstruction: A Comparison to NASBO

Abstract Aim Prompt diagnosis and proactive decisions in management of small bowel obstruction (SBO) can reduce the associated morbidity, in-hospital stay and mortality. Following recommendations of National Audit of Small Bowel Obstruction (NASBO) and Bologna (2017), the “agreed pathway” of The Association of Surgeons of Great Britain and Ireland (ASGBI, 2018) sets clear guidelines to aid timely management of SBO. We aimed to audit our practice to these guidelines and compared outcomes to NASBO. Methods Data was collected retrospectively on patients admitted with SBO from July 2019 - December 2019 and presented as percentage, median or interquartile range (IQR). Results Median age of 76 included patients was 62.0 years, 53.9% were female. Aetiologies were; adhesions (59.2%), hernia (27.6%), malignancy (10.5%) and others (2.6%). Admission CTs were performed in 92.1% vs. 80.0% (NASBO), with a median time of 3.3 hours vs. 2.2 days (NASBO). Median time to surgery in those managed operatively (n = 35) was 10 hours vs. 1 day (NASBO), while in 72.0% vs. 21.0% (NASBO) of non-settling SBO, water soluble contrast study (WSCS) was performed in a median (IQR) time of 39.0 (20.0-45.4) hours. Adhesional SBO resolved in 85.7% of cases suitable for non-operative approach. Objective nutritional assessment was performed in 94.7% vs. 90.0% (NASBO). In-hospital stay, 30-day morbidity and mortality compared to NASBO were 5.0 vs. 10.7 days, 31.6% vs. 23.0% and 5.3% vs. 8.0% respectively. Conclusion ASGBI guidelines provide multi-faceted proactive approach in managing SBO; including early cross-sectional imaging, prompt WSCS use and timely nutritional interventions, promoting improved outcomes.

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Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction

British Journal of Surgery ◽

10.1046/j.1365-2168.1998.00919.x ◽

1998 ◽

Vol 85 (12) ◽

pp. 1692-1694 ◽

Cited By ~ 75

Author(s):

Chen ◽

Lin ◽

Lee ◽

Yu ◽

Wang ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Water Soluble ◽

Early Surgery ◽

Adhesive Small Bowel Obstruction ◽

Contrast Study ◽

Water Soluble Contrast

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Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction

British Journal of Surgery ◽

10.1046/j.1365-2168.1999.1104g.x ◽

1999 ◽

Vol 86 (5) ◽

pp. 714-714 ◽

Cited By ~ 1

Author(s):

A. J. Spillane

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Water Soluble ◽

Early Surgery ◽

Adhesive Small Bowel Obstruction ◽

Contrast Study ◽

Water Soluble Contrast

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508 Conservative Management of Small Bowel Obstruction: A Local Experience

British Journal of Surgery ◽

10.1093/bjs/znab134.013 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Gonzalez ◽

M Aker ◽

P Manjunath ◽

A Mishra ◽

N Ward

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Positive Impact ◽

Statistical Significance ◽

Water Soluble ◽

Abdominal Adhesions ◽

Initial Management ◽

Local Experience ◽

Immediate Surgery

Abstract Introduction Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively. Method We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t. Results 118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p < 0.001). Conclusions Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.

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Therapeutic Role of Gastrograffin in Adhesive Small Bowel Obstruction After Unsuccessful Conservative Treatment

Med Phoenix ◽

10.3126/medphoenix.v5i1.31395 ◽

2020 ◽

Vol 5 (1) ◽

pp. 26-31

Author(s):

MD Alam Shahid ◽

Pashupati Bhatta ◽

Akash Raya ◽

Binod Kumar Rai

Keyword(s):

Small Bowel ◽

Conservative Treatment ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Appendectomy ◽

Sampling Technique ◽

Exploratory Laparotomy ◽

Water Soluble ◽

Adhesive Small Bowel Obstruction ◽

Therapeutic Role

Background: The management of adhesive small bowel obstruction is quite debatable. Gastrograffin, a water-soluble hyperosmolar contrast is used as a diagnostic tool widely but it also has impressive therapeutic role. Hence this study was to determine its therapeutic role in management of adhesive bowel obstruction after failure of conservative treatment. Methods: This cross-section observational study of 42 patients was conducted in 1-year duration from 01 July 2018 to 30 June 2019 using non-probability purposive sampling technique. All the patients were first managed conservatively for 48 hrs, and then given 100ml of gastrograffin through NG tube and clamped. Appearance of dye in cecum on radiograph at different time frame (4, 8, 12 and 24 hours of administration) signifies the success and who failed to do so within 24 hrs. were planned for laparotomy. Results: A total of 42 patients with their age ranged 14-80 years (mean 44.6) were included. Among them 32 (76.19%) were male and 10 (23.80%) female. Most had open appendectomy followed by gynaecological surgery and exploratory laprotomy. Majority had midline incision followed by gridiron and pfanensteil incision. After 8 hrs of gastrograffin administration, it was positive in 12 patients while 19 had at 24 hrs. Total 31 patients showed complete resolution, while remaining 11 showed no improvement and undergone exploratory laparotomy. Conclusion: Thus, the administration of gastrograffin is an effective approach in the management of adhesive small bowel obstruction after failed conservative management and prevents surgeries.

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