Efficacy of oral water soluble contrast medium (gastrografin) compared with standard conservative treatment in management of adhesive small bowel obstruction at mulago national hospital.

Abstract

Background: Adhesive small bowel obstruction (ASBO) is an important cause of hospital admission, repeated admission and its treatment is still controversial. Emergency surgery is mandatory when strangulation or complete obstruction occur. Non operative conservative management is indicated in the cases of partial obstruction. The operative rate for ASBO ranges from 27% to 42% Worldwide. Study Objective: To compare the efficacy of Gastrografin administration with standard conservative management in reducing hospital stay and the rate of laparotomies among patients with adhesive small bowel obstruction undergoing conservative management at Mulago Hospital. Methods: This was an open randomized controlled clinical trial, conducted between September 2012 and March 2013 among 50 patients with ASBO in the A&E ward (3BES) and general surgical wards. Patients were randomized either to Gastrografin group, receiving 100ml through a nasogastric tube or to standard conservative treatment. The outcome variables were the evaluation of the time interval between admission and relief of obstruction, the length of hospital stay, and the incidence of surgery in both groups. Follow-up of patients was up to the day of discharge. Results: A total of 50 patients were recruited, followed up and analysed. Twenty five (25) were in Gastrografin group and 25 were in standard conservative management. No significant differences were found in age, sex, level of education, previous type of surgery and duration of symptoms before admission. In Gastrografin group 22(88%) patients had relief of obstruction after administration of the contrast material. The remaining 3(12%) required surgery and all of them needed bowel resection due to complete obstruction of the bowel and colon tumour .In conservative group, 16(64%) patients had relief of obstruction. The remaining 9(36%) showed persistent untreatable obstruction and required surgery. Three (3) of them needed bowel resection due to strangulation and complete obstruction and 6 of them needed adhesiolysis only. The difference in operative rate between the two groups was not statistically significance (p-value 0.67). Average time to initiation of oral feeding was shorter in Gastrografin (72.52 hours) compared to (117.75hours) in conservative group. The average length of hospital stay was shorter in Gastrografin group 5.62 days compared to 10.88 days of the conservative group with a difference of 5.26 days (p- value 0.04).

Conclusion: The use of Gastrografin in patients with ASBO helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. It is safe, having no demonstrable adverse effects. Its role in reducing the rate of laparotomies remains inconclusive