scholarly journals Therapeutic effect of gastrografin and predictors of operative intervention in patients with adhesive small bowel obstruction: A randomized controlled study

2019 ◽  
Vol 35 (2) ◽  
pp. 131-135
Author(s):  
Hamid Reza Khorshidi ◽  
Parviz Majidi ◽  
Azar Pirdehghan
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Therapeutic Effect ◽  
Bowel Obstruction ◽  
Operative Intervention ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Adhesive Small Bowel Obstruction ◽  
Randomized Controlled

Bowel Ischemia Score Predicts Early Operation in Patients With Adhesive Small Bowel Obstruction

2021 ◽  
pp. 000313482098882
Author(s):  
Rachel S. Morris ◽  
Patrick Murphy ◽  
Kelly Boyle ◽  
Louis Somberg ◽  
Travis Webb ◽  
...  
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Characteristic Curve ◽  
Small Bowel Resection ◽  
Bowel Ischemia ◽  
Operative Intervention ◽  
Early Operation ◽  
Adhesive Small Bowel Obstruction

Background Nonoperative management of adhesive small bowel obstruction (SBO) is successful in up to 80% of patients. Current recommendations advocate for computed tomography (CT) scan in all patients with SBO to supplement surgical decision-making. The hypothesis of this study was that cumulative findings on CT would predict the need for operative intervention in the setting of SBO. Methods This is an analysis of a retrospectively and prospectively collected adhesive SBO database over a 6-year period. A Bowel Ischemia Score (BIS) was developed based on the Eastern Association for the Surgery of Trauma guidelines of CT findings suggestive of bowel ischemia. One point was assigned for each of the six variables. Early operation was defined as surgery within 6 hours of CT scan. Results Of the 275 patients in the database, 249 (90.5%) underwent CT scan. The operative rate was 28.3% with a median time from CT to operation of 21 hours (Interquartile range 5.2-59.2 hours). Most patients (166/217, 76.4%) with a BIS of 0 or 1 were successfully managed nonoperatively, whereas the majority of those with a BIS of 3 required operative intervention (5/6, 83.3%). The discrimination (area under the receiver operating characteristic curve) of BIS for early surgery, any operative intervention, and small bowel resection were 0.83, 0.72, and 0.61, respectively. Conclusion The cumulative signs of bowel ischemia on CT scan represented by BIS, rather than the presence or absence of any one finding, correlate with the need for early operative intervention.

scholarly journals Resolution of adhesive small bowel obstruction with a protocol based on Gastrografin administration

2019 ◽  
Vol 12 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Abhilash Paily ◽  
◽  
Jalpa Kotecha ◽  
Loveena Sreedharan ◽  
Bhaskar Kumar ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Therapeutic Effect ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Average Length ◽  
High Volume ◽  
Adhesive Small Bowel Obstruction ◽  
Retrospective Audit ◽  
Tertiary Center

The use of Gastrografin may have a therapeutic effect on resolving adhesive small bowel obstruction. Adhesive Small Bowel obstruction (ASBO) accounts for the majority of patients with small bowel obstruction. Most patients are managed conservatively; frequent admissions create a considerable burden. We sought to examine the adherence to the Bologna guidelines for the management of ASBO in a high volume tertiary center and whether or not Gastrografin had a therapeutic effect. A comparison was made between an initial retrospective audit looking at ASBO and a prospective re-audit after applying standards derived from the Bologna guidelines. During re-audit it was found that more patients underwent conservative management and fewer patients had surgery as first line management. In the re-audit, those who had to undergo surgery within/after a period of 72h of conservative management were also fewer. Whether they were managed surgically primarily or after a period of conservative management, the average length of stay was also shorter. In comparison to the preliminary audit, there appeared to be no change in the way that medical history and physical examination was documented during the re-audit. However, there was a marked difference in the use of appropriate blood tests and CT scans. Changes were made successfully following the initial audit results and have been implemented, thus closing the audit loop. This study shows that the use of Gastrografin has decreased the need for surgical intervention in a group of patients with small bowel obstruction.

Randomized controlled trial of Gastrografin in adhesive small bowel obstruction

2005 ◽  
Vol 75 (8) ◽  
pp. 672-674 ◽  
Author(s):  
Jonathan Burge ◽  
Saleh M. Abbas ◽  
Graeme Roadley ◽  
Jennifer Donald ◽  
Andrew Connolly ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Controlled Trial ◽  
Adhesive Small Bowel Obstruction ◽  
Randomized Controlled

Adhesive Small Bowel Obstruction Protocol in Geriatric Patients

2019 ◽  
Vol 229 (4) ◽  
pp. S87
Author(s):  
Jose A. Aldana ◽  
Javier E. Rincon ◽  
Ricardo A. Fonseca ◽  
Rohit K. Rasane ◽  
Christina X. Zhang ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Geriatric Patients ◽  
Adhesive Small Bowel Obstruction

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

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