A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin

Michelle B. Mulder, Matthew Hernandez, Mohamed Ray-Zack, Daniel C. Cullinane, David Turay, Salina Wydo, Martin Zielinski, D. Dante Yeh

Research output: Contribution to journalArticle

Abstract

Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results: Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). Conclusions: A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence: Level II.

Original languageEnglish (US)
Pages (from-to)408-412
Number of pages5
JournalJournal of Surgical Research
Volume233
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Keywords

  • Gastrografin
  • Nonoperative management
  • Small bowel obstruction

ASJC Scopus subject areas

  • Surgery

Cite this

Mulder, M. B., Hernandez, M., Ray-Zack, M., Cullinane, D. C., Turay, D., Wydo, S., Zielinski, M., & Yeh, D. D. (2019). A significant proportion of small bowel obstructions require >48 hours to resolve after gastrografin. Journal of Surgical Research, 233, 408-412. https://doi.org/10.1016/j.jss.2018.08.019