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Introduction: Early small bowel obstruction (ESBO) following abdominal surgery presents a diagnostic and therapeutic challenge. Abdominal imaging using Gastrografin (GG), has been shown to have diagnostic and therapeutic properties when used in the setting of small bowel obstruction outside the early postoperative period (> 6weeks). We hypothesize that a GG challenge will reduce need for re-exploration in patients with ESBO.
Methods: Patients with ESBO (< 6 weeks following abdominal surgery) who underwent a GG challenge between 2010 - 2012 were case controlled, based on age ± 5 and sex, to an equal number of patients that did not receive a GG challenge. Groups were compared to assess differences in rates of reoperation for obstruction.
Results: 105 patients with ESBO who received a GG challenge. There were 76 males in each group (72%) with an average age of 64 years (range, 59-68). An open or laparoscopic approach in the index operation was done equally between groups (67% vs 70% and 33% vs 30%, respectively p=0.44). The mean time from surgery to GG challenge was (11.3, range=9.8-12.9) days. There was no difference between groups in the rate of re-operation (12% vs 9%, p=0.48), days from surgery to re-operation (9.1 [range 4.2-14] vs 13.5 [range 7.9-19.2], p=0.23), morbidity (35% vs 42%, p=0.23), and mortality (8% vs 7%, p=0.78). Hospital length of stay was greater in patients who received GG (18.2 vs 11.5, p=0.0001) days. There were no GG aspiration events. . There were more patients that received abdominal computed tomography in the GG group (74% vs 45%, p=0.0001), of these patients, the GG group were more likely to have a transition point (55% vs 33%, p=0.01).The GG challenge had a positive predictive value of 91%, negative predictive value of 50%, sensitivity of 96% and specificity of 30% to predict ESBO resolution without operative intervention.
Conclusion: Use of the GG challenge in the immediate postoperative period appeared to be safe. There was no difference, however, in the rate of re-exploration between groups. Further study in a prospective, randomized fashion is needed to elucidate the effects of GG in ESBO.