Use of gastrografin in the management of worm-induced small bowel obstruction in children
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Ascaris-induced small bowel obstruction (SBO) is a common sequel of Ascaris lumbricoides (AL) infestation. Most cases respond to conservative treatment practiced in different centers worldwide. We conceived a prospective randomized trial to compare the conservative treatment with gastrografin administered in addition to the conservative treatment.
This prospective randomized study was conducted between January 2011 and June 2014 at Department of Paediatric and Neonatal Surgery, a tertiary-care hospital. Patients were divided into two groups, one group received conservative treatment and the other received gastrografin in addition to conservative treatment. Forty patients having uncomplicated AL-induced SBO were included in each group. Gastrografin was administered through nasogastric tube and serial clinical and radiological monitoring was performed. The duration of hospital stay, time between admission and first oral feed, passage of worms/flatus were compared in the two groups. Student’s t test was used for comparing these variables.
Average time for passage of flatus or worms and resolution of abdominal signs and was shorter in gastrografin group as compared to the conservative group. This difference was found to be statistically significant. The average duration of hospital stay in gastrografin group was 25.20 ± 8.01 h whereas it was 61.12 ± 14.64 h in the conservative group (P < 0.001). The difference in the operation rate was statistically insignificant (2 in gastrografin group and 3 in the conservative group).No serious adverse reaction was noted after gastrografin administration.
Use of gastrografin resulted in faster relief of signs and symptoms of AL-induced SBO, early passage of worms/flatus and return to oral feeds. However, the role of gastrografin role in reducing the likelihood of laparotomy remains inconclusive. Adverse effects of gastrografin can be prevented if it is used in well-hydrated patients.
KeywordsGastrografin (Sodium Amidotrizoate 100 mg/mL, Meglumine Amidotrizoate) 660 mg/mL Ascaris lumbricoides (AL) Small bowel obstruction (SBO) Nasogastric tube (NGT)
- 9.Esposito C, Settimi A, De Marco M, De Fazio C, Giurin I, Savanelli A et al (2008) Surgical complications of ascariasis in children. J Pediatric Surg 2:8–12Google Scholar
- 10.Puneet, Tiwary SK, Singh S, Agarwal S, Khanna AK (2006) Gallbladder ascariasis: A Case Report. The Internet J Parasitic Dis [Internet] 1(1). Available from: http://www.ispub.com/journal/the-internet-journal-of-parasitic-diseases/volume-1-number-1/gallbladder-ascariasis-a-case-report
- 17.Haule C, Ongom PA, Kimuli T (2014) Efficacy of gastrografin compared with standard conservative treatment in management of adhesive small bowel obstruction at Mulago Natinal Referral Hospital. J Clin Trials 3:2167–2170Google Scholar
- 25.Kumar H, Jain CK, Jain MR (2014) A study of prevalence of intestinal worm infestation and efficacy of anthelminthic drugs Brig Medical journal armed forces india 70: 144–48Google Scholar