An audit of the upper gastrointestinal contrast examination protocol in patients with suspected small bowel obstruction

Abstract

Objective: Small bowel follow-through examination with Gastrografin (diatrizoate meglumine and diatrizoate sodium solution) is important for delineating the cause of small bowel obstruction. However, whether the standard protocol should include the 24-hour delayed image is uncertain. This retrospective study was performed to review the usefulness of the 24-hour delayed image and the subsequent treatment of patients suspected to have small bowel obstruction. Methods: All urgent Gastrografin follow-through examinations conducted from 1 January 2007 to 31 December 2007 were evaluated. Clinical data, including demographic data, presenting symptoms, imaging findings, subsequent treatment, and clinical outcomes were reviewed from the Electronic Patient Record, Radiology Information System, and medical records. Results: Seventy five examinations were performed, and 4 patients were excluded because of intolerance and subsequent incomplete examination. The commonest indication was acute small bowel obstruction (n = 66; 93%). Of 21 patients (30%) with positive results, 6 had significant small bowel obstruction diagnosed by imaging within 8 hours with no 24-hour delayed image, and 5 of these patients underwent emergency operation; the sixth patient rapidly worsened preoperatively. Of 15 patients with positive results confirmed by 24-hour delayed images, 14 required emergency operation, with complete bowel obstruction confirmed intraoperatively. For the 50 patients with negative results, 9 (18%) required 24-hour delayed images to confirm the radiological diagnosis, 3 (33%) of whom underwent emergency operation due to their deteriorating clinical condition; complete bowel obstruction was confirmed intraoperatively for all 3 patients. Conclusions: This audit of the role of 24-hour delayed imaging had a high false-negative rate (30%). Therefore, the standard protocol may be amended to eliminate the 24-hour delayed image to avoid delay to effective management of small bowel obstruction. © 2009 Hong Kong College of Radiologists.