627 The Use of Gastrograffin in Adhesive Small Bowel Obstruction (ASBO)
T Tabassum, S Rehman, M Ibrahim- Surgery
Abstract
Background
SBO constitutes 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. As per Bologna guidelines, partial adhesive small bowel obstruction (ASBO) can be managed safely with non-operative management with WSCM and tube decompression. The radiologic appearance of WSCM in colon within 24hrs from administration predicts resolution. According to NASBO recommendations, WSCM should be embedded into prognostic and therapeutic management of ASBO. We investigated the use of gastrografin amongst patients who had ASBO and audited the practice in our hospital.
Method
We collected and analysed retrospective data of patients who received gastrografin from February 2022 to September 2022. CTscan-identified ASBO cases were included. We excluded cases of gastrografin use for other bowel obstruction aetiologies e.g. hernias, extrinsic compression, post-operative ileus, or when CT scan did not explicitly report adhesive aetiology.
Results
In 54 patients who received gastrografin, 27 were identified to be for ASBO by CT scan (50%). Of these, 24 (89%) received gastrografin within 24 hours of NG tube insertion. 21 (78%) successfully resolved with gastrografin administration alone with 6 (22%) going on to have surgery. The mean duration of conservative management in gastrografin-resolved ASBO was 2 days.
Conclusions
We demonstrate that non-operative management should initially be attempted in patients with uncomplicated partial ASBO, with gastrografin use showing therapeutic benefit. Lack of resolution after 24hrs of administration should be considered for surgical adhesiolysis. CT reporting of specific SBO aetiology should be encouraged to better guide whether gastrografin is indicated.