Optimal Timing of First Abdominal Radiography after Gastrografin Administration for Small Bowel Obstruction

Omar Alnachoukati; Mohamed Ray-Zack; Sam Godin; Taylor Apodaca; Martin Zielinski; Julie Dunn

doi:10.1016/j.jss.2020.06.053

Optimal Timing of First Abdominal Radiography after Gastrografin Administration for Small Bowel Obstruction

J Surg Res. 2020 Dec:256:193-197. doi: 10.1016/j.jss.2020.06.053. Epub 2020 Jul 22.

Authors

Omar Alnachoukati¹, Mohamed Ray-Zack², Sam Godin¹, Taylor Apodaca¹, Martin Zielinski², Julie Dunn³

Affiliations

¹ Trauma and Acute Care Surgery, University of Colorado Health Medical Center of the Rockies, Loveland, Colorado.
² Department of Surgery, Mayo Clinic, Rochester, Minnesota.
³ Trauma and Acute Care Surgery, University of Colorado Health Medical Center of the Rockies, Loveland, Colorado. Electronic address: Julie.dunn@uchealth.org.

PMID: 32711175
DOI: 10.1016/j.jss.2020.06.053

Abstract

Background: Water-soluble contrast agent (WSCA) administration is commonly used to evaluate adhesive small bowel obstruction (SBO) either via a challenge or follow-through study. This analysis aimed to determine optimal timing to first abdominal radiograph after WSCA administration.

Materials and methods: A post hoc review of the Eastern Association for the Surgery of Trauma SBO database was used to compare data from two institutions using different methodologies, either the small bowel follow through method or the challenge method, from March 2015-January 2018. The primary outcome was timing of contrast into the colon. Outcomes were also analyzed. A multivariate regression analysis controlled for age, sex, body mass index, previous SBO admissions, and abdominal surgeries.

Results: A total of 236 patients met inclusion and exclusion criteria (A, 119; B, 117). There were minor demographic differences between cohorts and no significant differences between institutions regarding the confirmed presence of WSCA in the colon, rates of operative intervention, length of operation, hospital length of stay, or 30-d readmission rates.Institution A, where the challenge method was practiced, had 95 (80%) patients with contrast to colon overall; four of 95 (4%) patients had confirmed contrast to colon at or before 7 h, and 89 of 95 (94%) patients had confirmed contrast to colon between 7.1 and 10 h. Institution B, where the small bowel follow through method was practiced, had 94 (80%) patients with contrast to colon overall; 73 of 94 (78%) patients had confirmed contrast to colon at or before 7 h, and 15 of 94 (16%) patients had confirmed contrast to colon between 7.1 and 10 h.

Conclusions: Either method is effective for evaluation of SBO. Adding a radiograph at 4 h is feasible, could promote earlier disposition, be conducted as part of an emergency department protocol, and possibly allow for the selection of patients who are candidates for outpatient treatment.

Keywords: Adhesive small bowel disease; Gastrografin; Optimal timing; Small bowel obstruction; Water-soluble contrast.

MeSH terms

Aged
Aged, 80 and over
Clinical Decision-Making
Contrast Media / administration & dosage*
Diatrizoate Meglumine / administration & dosage
Feasibility Studies
Female
Humans
Intestinal Obstruction / diagnosis*
Intestinal Obstruction / etiology
Intestinal Obstruction / surgery
Intestine, Small / diagnostic imaging*
Intestine, Small / surgery
Length of Stay
Male
Middle Aged
Patient Readmission / statistics & numerical data
Patient Selection
Preoperative Care / methods*
Radiography / methods
Time Factors
Tissue Adhesions / complications
Tissue Adhesions / diagnosis*
Tissue Adhesions / surgery

Substances

Contrast Media
Diatrizoate Meglumine