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

• 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
• Subjects: Abdomen; Adult; Aged; Clinical Decision-Making - methods; Colon; Complications; Contrast Media; Demographics; Demography; Diagnosis, Differential; Diagnostic systems; Edema; Female; Hospitals; Humans; Intestinal obstruction; Intestinal Obstruction - diagnostic imaging; Intestinal Obstruction - pathology; Intestinal Obstruction - surgery; Intestine, Small - diagnostic imaging; Intestine, Small - pathology; Intestine, Small - surgery; Male; Middle Aged; Obstructions; Pain; Patients; Retrospective Studies; Small intestine; Surgeons; Surgery; Tomography, X-Ray Computed - methods; Treatment Outcome; Water chemistry
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.02.034

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.