The Diagnostic and Therapeutic Value of Gastrografin in Small Bowel Obstructions

Roberta Tutino ^1* Mariachiara Cavaglià ¹ Nicoletta Sveva Pipitone ¹ Veronica De Simone ² Giacomo Deiro ¹ Gaetano Gallo ^3* Mauro Santarelli ¹

• ¹ UOC Chirurgia Generale, d’Urgenza e PS, Dipartimento di Chirurgia Generale e Specialistica, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
• ² Agostino Gemelli University Polyclinic (IRCCS), Rome, Lazio, Italy
• ³ Department of Surgery, Sapienza University of Rome, Rome, Italy

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.