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Failure of conservative treatment with Gastrografin® for adhesive small bowel obstruction after colorectal surgery

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Abstract

Purpose

The aim of this study was to identify risk factors related with failure of conservative management of adhesive small bowel obstruction (ASBO) in patients with previous colorectal surgery.

Methods

Patients admitted with the diagnosis of ASBO after previous colorectal resection, were included. All patients underwent administration of Gastrografin®. Abdominal radiography was done after 24 h, to confirm the presence of contrast in colon (incomplete obstruction) or not (complete obstruction). Several factors were investigated to study their relationship with the failure of conservative management. Failure of conservative management was considered when emergency operation was needed to solve ASBO.

Results

Incomplete obstruction was observed in 174 episodes (93.0%) while in 13 (7.0%) was complete. One hundred seventy-one ASBO episodes (91.4%) responded successfully to nonoperative treatment and 16 (8.6%) required emergency surgery. Five patients needed bowel resection. Results on the diagnostic test with Gastrografin® showed a sensitivity of 75%, specificity of 99%, positive predictive value 92%, and negative predictive value 98%. Age over 75 years was the only predictive factor for failure of conservative management. The median waiting time from the radiologic confirmation of complete obstruction to surgery was higher in patients requiring bowel resection when compared to those who did not need resection.

Conclusions

The use of Gastrografin® in ASBO after colorectal resection is a safe and useful tool for the indication of conservative management. Age over 75 years is a predictive factor for need of surgery. Surgery should be performed no later than the following 24 h of confirmed complete obstruction.

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Acknowledgements

The authors thank Mr. Bernat Miguel, Data Manager of the Colorectal Unit, University Hospital of Bellvitge and IDIBELL, for the statistical analysis.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain

    Jordi Miquel, Sebastiano Biondo, Esther Kreisler, Catalina Uribe & Loris Trenti

  2. Department of General and Digestive Surgery, Bellvitge University Hospital, C/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Sebastiano Biondo

Authors
  1. Jordi Miquel
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  2. Sebastiano Biondo
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  3. Esther Kreisler
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  4. Catalina Uribe
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  5. Loris Trenti
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Corresponding author

Correspondence to Sebastiano Biondo.

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The authors declare that they have no conflict of interest.

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Miquel, J., Biondo, S., Kreisler, E. et al. Failure of conservative treatment with Gastrografin® for adhesive small bowel obstruction after colorectal surgery. Int J Colorectal Dis 32, 1051–1055 (2017). https://doi.org/10.1007/s00384-017-2786-8

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  • DOI: https://doi.org/10.1007/s00384-017-2786-8

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