WATER SOLUBLE CONTRAST STUDY PREDICTS THE NEED FOR EARLY SURGERY IN ADHESIVE SMALL BOWEL OBSTRUCTION

The study was carried out with the aim to investigate whether the water soluble contrast study followed for 24 hours can be a reliable indicator of the need for earlier surgical intervention in adhesive small bowel obstruction or not? To avoid much dreaded complications like bowel strangulation due to delayed surgical intervention, and to determine the management approach for patients in whom avoiding surgery is highly desirable such as those with multiple previous abdominal operations or small bowel obstruction in the early post-operative period. 40 patients admitted in emergency with clinical and radiologic evidence of adhesive small bowel obstruction were included in this study. All patients were treated conservatively for initial 48 hours. The Gastrograffin study was performed in 28 patients after 48 hours as12 patients showed spontaneous relief in symptoms of obstruction within 48 hours and were managed conservatively. 25 cases showed contrast agent beyond Ileocecal junction on plain radiograph in erect posture before 24 hours of ingestion of oral contrast and conservative treatment was continued. The remaining 3 cases had complete obstruction as shown by the contrast study and underwent surgery. The use of water soluble contrast agent Gastrograffin in adhesive small bowel obstruction after failed conservative treatment can be of great help in diagnosis and management of adhesive small bowel obstruction.