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Obstruction reduction: Use of water-soluble contrast challenge to differentiate between partial and complete small bowel obstruction

Differentiating SBO that will resolve conservatively from those requiring surgery remains challenging. Water-soluble contrast administration may be diagnostic and therapeutic. Our study evaluated use of a WSC challenge protocol. We hypothesize that protocol use discriminates between surgical SBO and...

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Bibliographic Details
Published in:The American journal of surgery 2019-11, Vol.218 (5), p.913-917
Main Authors: Moskowitz, Eliza, Campion, Eric M., Burlew, Clay Cothren, Helmkamp, Laura J., Peltz, Erik D., Gansar, Brittany L., McIntyre, Robert C.
Format: Article
Language:English
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Summary:Differentiating SBO that will resolve conservatively from those requiring surgery remains challenging. Water-soluble contrast administration may be diagnostic and therapeutic. Our study evaluated use of a WSC challenge protocol. We hypothesize that protocol use discriminates between surgical SBO and obstructions which can be managed non-operatively. Demographics, prior surgeries, time to operation, complications, and LOS were analyzed. 108 patients were admitted with SBO. 13% underwent immediate laparotomy with concern for bowel compromise; these had a median LOS of 8.5 days. 91 received WSC protocol. Of these, 77% had contrast passage to the colon. Of the 48 in whom contrast passed between 0 and 12 h, LOS was 2 days. Of the 22 patients in whom contrast passed between 12 and 24 h, LOS was 4.5 days. 21 had failure of contrast passage; 18 of those underwent surgery after 24 h as a result. Of the 21 patients who failed WSC challenge, median LOS was 8 days. WSC protocol implementation facilitates early recognition of partial from complete obstruction and may decrease LOS. Our findings warrant further evaluation with a multicenter trial. •Water-soluble contrast (WSC) administration may be diagnostic and therapeutic in small bowel obstruction. Our study evaluated use of a WSC challenge protocol.•Patients with immediate OR had a LOS of 8.5 days. Contrast passage between 0-12 h, LOS was 2 days, 12-24 h LOS was 4.5 days, and those with failure of contrast passage LOS was 8 days.•Our findings demonstrate that use of a WSC protocol can facilitate early recognition of partial from complete obstruction and may decrease LOS.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2019.02.034