Abstract
Background
Several studies have investigated the diagnostic and therapeutic role of water-soluble contrast agents (WSCAs) in adhesive small bowel obstruction (SBO). However, the clinical effect of WSCA for SBO without previous intraabdominal operation (i.e., virgin abdomen, VA) is unclear. The aim of this study was to clarify the clinical effect of WSCA for SBO in the VA.
Methods
Between January 2008 and December 2015, 838 consecutive patients with SBO were initially managed with WSCA and were included in the study. Abdominal X-rays were taken 5 h after administration of 100 ml WSCA and classified into complete/incomplete obstruction groups. The medical records of the patients with SBO were retrospectively analyzed and divided into two groups of patients with VA or non-VA.
Results
A total of 44 and 794 VA and non-VA patients were identified, respectively. Six VA patients (13%) and 121 non-VA patients (15%) were classified with complete obstruction (p = 1.000) and subjected to operative exploration on the same day. There were no significant differences in the duration of nasogastric tube decompression (2.2 versus 2.5 days, p = 0.400) and intervals until the initiation of oral intake (2.4 versus 2.6 days, p = 0.553) between the VA and non-VA groups. The overall operative rate was 16% in the VA and 17% in the non-VA groups (p = 1.000). Compared with non-VA, VA was associated with shorter hospital stays (9.6 versus 11.3 days, p = 0.006).
Conclusions
WSCA for SBO in the VA is as effective as in non-VA patients in terms of a therapeutic strategy.
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References
Seror D, Feigin E, Szold A, Allweis TM, Carmon M, Nissan S et al (1993) How conservatively can postoperative small bowel obstruction be treated? Am J Surg 165:121–125
Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW (1993) The operative aetiology and types of adhesions causing small bowel obstruction. Aust N Z J Surg 63:848–852
Matter I, Khalemsky L, Abrahamson J, Nash E, Sabo E, Eldar S (1997) Does the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg 163:767–772
Bueno-Lledó J, Barber S, Vaqué J, Frasson M, Garcia-Granero E, Juan-Burgueño M (2016) Adhesive small bowel obstruction: predictive factors of lack of response in conservative management with gastrografin. Dig Surg 33:26–32
Beardsley C, Furtado R, Mosse C, Gananadha S, Fergusson J, Jeans P, Beenen E (2014) Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. Am J Surg 208:243–248
Tavangari FR, Batech M, Collins JC, Tejirian T (2016) Small bowel obstructions in a virgin abdomen: is an operation mandatory? Am Surg 82:1038–1042
Omori H, Asahi H, Inoue Y, Irinoda T, Saito K, Wakabayashi G (2006) Etiology of intestinal obstruction in patients without a prior history of laparotomy or a detectable external hernia on physical examination. Int Surg 91:188–193
Makar RA, Bashir MR, Haystead CM, Iseman C, Mayes N, Hebert S, Allen BC, Bhattacharya SD, Choudhury KR, Jaffe TA (2016) Diagnostic performance of MDCT in identifying closed loop small bowel obstruction. Abdom Radiol (NY) 41:1253–1260
Choi HK, Chu KW, Law WL (2002) Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 236:1–6
Biondo S, Parés D, Mora L, Martí Ragué J, Kreisler E, Jaurrieta E (2003) Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction. Br J Surg 90:542–546
Williams SB, Greenspon J, Young HA, Orkin BA (2005) Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 48:1140–1146
Ji ZL, Li JS, Yuan CW, Chen WD, Zhang YN, Ju XT et al (2010) Therapeutic value of sesame oil in the treatment of adhesive small bowel obstruction. Am J Surg 199:160–165
Fleshner PR, Siegman MG, Slater GI, Brolin RE, Chandler JC, Aufses AH Jr (1995) A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg 170:366–370
Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S (2014) Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Br J Surg 101:433–437
Abbas SM, Bissett IP, Parry BR (2007) Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg 94:404–411
Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D (2010) Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 97:470–478
Isogai M, Hachisuka K, Yamaguchi A, Mayumi T, Shiomi M, Kondo S et al (1992) The indication and timing of surgery for patients with small intestinal obstruction (in Japanese). Prog Acute Abdom Med 12:363–368
Mori H, Kaneoka Y, Maeda A, Takayama Y, Takahashi T, Onoe S, Fukami Y (2017) Determination of therapeutic strategy for adhesive small bowel obstruction using water-soluble contrast agents: an audit of 776 cases in a single center. Surgery. doi:10.1016/j.surg.2017.01.023
Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH (2017) Abdominal adhesions: a practical review of an often overlooked entity. Ann Med Surg (Lond). 15:9–13
Ng YY, Ngu JC, Wong AS (2016) Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence. ANZ J Surg. doi:10.1111/ans.13714
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YF designed the study and wrote the initial draft of the manuscript. YK contributed to interpretation of the data and the critical revision of the manuscript for important intellectual content. All the other authors (AM, YT, TT, and MU) contributed to the data collection and interpretation and critically reviewed the manuscript. All the authors have read and approved the final version of the manuscript, and have agreed to be accountable for all aspects of the study, ensuring that any questions related to the accuracy or integrity of any part of the work are answerable.
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Fukami, Y., Kaneoka, Y., Maeda, A. et al. Clinical Effect of Water-Soluble Contrast Agents for Small Bowel Obstruction in the Virgin Abdomen. World J Surg 42, 88–92 (2018). https://doi.org/10.1007/s00268-017-4174-5
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DOI: https://doi.org/10.1007/s00268-017-4174-5