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Article: Therapeutic value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective randomized trial

TitleTherapeutic value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective randomized trial
Authors
Issue Date2002
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2002, v. 236 n. 1, p. 1-6 How to Cite?
AbstractObjective: To assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment. Summary Background Data: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction. Methods: Patients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed. For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement. Results: One hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group. Conclusions: The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails.
Persistent Identifierhttp://hdl.handle.net/10722/49339
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChoi, HKen_HK
dc.contributor.authorChu, KWen_HK
dc.contributor.authorLaw, WLen_HK
dc.date.accessioned2008-06-12T06:39:50Z-
dc.date.available2008-06-12T06:39:50Z-
dc.date.issued2002en_HK
dc.identifier.citationAnnals Of Surgery, 2002, v. 236 n. 1, p. 1-6en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49339-
dc.description.abstractObjective: To assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment. Summary Background Data: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction. Methods: Patients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed. For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement. Results: One hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group. Conclusions: The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshAdhesions - complications - surgery - therapyen_HK
dc.subject.meshContrast Media - administration & dosageen_HK
dc.subject.meshDiatrizoate Meglumine - administration & dosageen_HK
dc.subject.meshIntestinal Obstruction - etiology - radiography - surgery - therapyen_HK
dc.subject.meshAdministration, Oralen_HK
dc.titleTherapeutic value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective randomized trialen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=236&issue=1&spage=1&epage=6&date=2002&atitle=Therapeutic+value+of+gastrografin+in+adhesive+small+bowel+obstruction+after+unsuccessful+conservative+treatment:+a+prospective+randomized+trialen_HK
dc.identifier.emailLaw, WL: lawwl@hkucc.hku.hken_HK
dc.identifier.authorityLaw, WL=rp00436en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/00000658-200207000-00002en_HK
dc.identifier.pmid12131078-
dc.identifier.pmcidPMC1422541en_HK
dc.identifier.scopuseid_2-s2.0-0036287806en_HK
dc.identifier.hkuros81114-
dc.identifier.hkuros71543-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036287806&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume236en_HK
dc.identifier.issue1en_HK
dc.identifier.spage1en_HK
dc.identifier.epage6en_HK
dc.identifier.isiWOS:000177004800001-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridChoi, HK=7404339913en_HK
dc.identifier.scopusauthoridChu, KW=7402453653en_HK
dc.identifier.scopusauthoridLaw, WL=7103147867en_HK

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