ABSTRACT

Objective Evaluation of therapeutic role of Gastrografin in the management of small bowel obstruction post conventional line of treatment which is conservative management is deemed unsuccessful in the treatment of the same Framework The contrast medium used for the above study is gastrografin which is a water soluble and hyperosmolar in nature. Gastrografin has been helpful in predicting the requirement of surgery. In this study we will also assess its usefulness as a therapeutic agent in small bowel obstruction Methods Patients presenting with signs and symptoms pertaining to that of adhesive small bowel obstruction were given a trial conservative management excluding those cases in which strangulation of bowel was suspected. The subjects who elicited a response to conservative line of management within forty-eight hours of time period were continued with conservative line of management. Subjects exhibiting no betterment within the initial forty-eight hours either by signs /symptoms or radiological studies had been randomized to ahead with Gastrografin meal along with follow-through observation or surgical treatment. The subjects were further evaluated in accordance to visualisation of gastrografin in large bowel within a time period of 24 hours. If gastrografin was present in the large bowel after 24 hours, the subject was considered to be suffering from “partial” small bowel obstruction and therefore the conservative line of management was continued. On the other hand, subjects in whom abdominal x-ray did not show appearance of contrast in large bowel were treated with exploratory laparotomy eventually Results Keeping all the signs and symptoms of small bowel obstruction, 124 patients with a total of 139 episodes of small bowel obstruction were taken in consideration for the study. 3 patients required immediate surgical treatment on admission due to high suspicion of strangulated bowel out of which strangulation was confirmed in two patients due to intra-op findings. One hundred episodes of obstruction elicited significant improvement within the given time period of initial forty-eight hours and as a result of this conservative treatment was continued for those patients. Out of these patients, only one subject underwent surgery after receiving conservative remedy for six days which was considered unsuccessful. 35 patients did not show any signs of improvement in the initial forty-eight hours. The usage of gastrografin in 14 patients revealed partial obstruction. Obstruction got relieved in all of the subjects sooner or later after a median of 41 hours. The five patients left underwent exploratory laparotomy as the gastrografin study pointed towards complete obstruction. Hence the usage of Gastrografin as a result caused reduction in the need of performing surgery surgical procedure by 74 percent. No complication occurred in the course of this study which could be attributed to use of gastrografin. No subject underwent strangulation of bowel in both groups Conclusions Hence using Gastrografin in cases with provisional diagnosis of adhesive small bowel obstruction is in comparison safer and reduces the requirement of surgery in cases where conservative treatment fails to show desired results. Keywords: Gastrografin, Bowel Obstruction, Post Conservative Treatment
Publication date: 15/02/2022

https://ijbpas.com/pdf/2022/February/MS_IJBPAS_2022_FEB_SPCL_1002.pdf

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https://doi.org/10.31032/IJBPAS/2022/11.2.1002