Résumé
In adhesive small bowel obstruction [ASBO], the early recognition of complications and the optimal period of conservative treatment are essential. This study sought to determine whether oral gastrografin followed for 24 hours can be a reliable indicator of the need for operation and whether it has a therapeutic effect in cases of ASBO. Seventy-two patients who suffered from ASBO without clinical evidence of strangulation were randomized into a control group [32 patients], who were treated with conventional methods, and a gastrografin group [40 patients] who were treated with gastrografin administered orally or through the nasogastric tube. Serial plain abdominal X-rays were taken 4, 8, 16, 24 hours later. Subsequent X-rays were cancelled if an earlier X-ray showed gastrografin reaching the colon. The following variables were examined: time to resolution of obstruction, the need for operation, and hospital stay.In the gastrografin group, the contrast material reached the colon within 24 hours in 28 patients [70%]. These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the 1[st] 24 hours in 12 patients [30%], operation was performed in 10 of these patients. In the control group, 18 patients [56.25%] were treated successfully with non-operative method in the 1[st] 24 hours and 11 patients treated operatively later on. Mean timing of the 1[st] stool was 2.27 days in the control group and 0.81 days in the gastrografin group [p<0.005]. Mean hospital stay for the patients who respond to conservative treatment was 6.25 days and 3.1 days in the control and gastrografin groups respectively [p<0.005]. No gastrografin related complications were observed. Oral gastrografin significantly prompts the resolution of ASBO and shortens hospital stay. All patients with evidence of gastrografin reaching the colon within 24 hours were treated successfully with non-operative methods. Failure of gastrografin to reach the colon within 24 hours is an indication for prompt surgical intervention