The diagnostic and therapeutic value of Gastrografin in small bowel obstructions

Purpose: Small bowel obstructions represent a major cause of hospitalization, morbidity and mortality in surgical emergency departments. The Gastrografin protocol could be an effective tool in facilitating its evaluation and treatment. Methods: A prospective observational study was conducted on patients admitted to the emergency department with a diagnosis of small bowel obstruction treated with the Gastrografin challenge to analyze risk factors related to the outcome. Results: 55 patients were included. In 38 patients (69.09%) the resolution of the occlusive condition was obtained. The progression of Gastrografin in the colon at x-ray was correlated to the positive outcome (p = 0.001). Older (>75 years old) and frailer patients were related to protocol failure and submitted more to surgery (p = 0.043; p = 0.022). Air-fluid levels at x-ray was related to negative outcome (P = 0.027). Higher doses of Gastrografin (100 ml vs. 50 ml) seems unrelated to obstruction resolution. At the two-year follow-up, among the 38 patients who tested positive, 8 patients (21.05%) had further access to the emergency department due to intestinal obstruction and were re-treated conservatively. Conclusions: The standardized diagnostic-therapeutic protocol with Gastrografin is a valid tool in the non-operative management of small bowel obstructions offering a resolution of the obstructive condition in 70% of patients.