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Defining the Need for Surgery in Small-Bowel Obstruction

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Small-bowel obstruction is a frequent disorder in emergency medicine and represents a major burden for patients and health care systems worldwide. Within the past years, progress has been made regarding the management of small-bowel obstructions, including the use of contrast agent swallow as a tool in the decision-making process.

Objectives

This is a prospective controlled study investigating the central role of contrast agent swallow in the diagnostic and treatment algorithm for small-bowel obstruction at a university department of surgery. Endpoints were the correct identification of patients who needed operative treatment and the accuracy of a conservative treatment decision including the analysis of dropout from this routine algorithm.

Methods

We performed a single-center analysis of 181 consecutive patients diagnosed with a small-bowel obstruction based on clinical, radiologic, and sonographic findings. Patients with clinical signs of strangulation or peritonitis underwent immediate surgery (group 1). Patients without signs of peritonitis and incomplete stop in the initial abdominal plain film were considered eligible for Gastrografin® challenge (group 2).

Results

Seventy-six of the 181 patients (42.0%) underwent immediate surgery. A Gastrografin® challenge was initialized in 105 of the 181 patients (58.0%). Twenty of these 105 patients (19.1%) with persisting or progressive symptoms and absence of contrast agent in the colon after 12 and 24 h subsequently underwent surgery. Here, a segmental bowel resection was necessary in 6 of these 20 patients (30.0%). In 16 out of 20 patients (80.0%) who failed the Gastrografin® challenge, a corresponding correlate in terms of a strangulation was detected intraoperatively. The Gastrografin® challenge had a specificity of 96% and a sensitivity of 100%; accuracy to predict the need for exploration was 96%.

Conclusion

A straightforward algorithm based mainly on contrast agent swallow for patients with small-bowel obstructions enabled a timely and very accurate differentiation between patients qualifying for conservative and operative treatment.

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Acknowledgements

We would like to thank Robin Vasan, M.D., Research Fellow at the Massachusetts General Hospital in Boston for the language revision of the manuscript.

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Authors and Affiliations

  1. Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany

    Florian Kuehn, Malte Weinrich, Sarah Ehmann & Ernst Klar

  2. Institute of Diagnostic and Interventional Radiology, University of Rostock, 18057, Rostock, Germany

    Katja Kloker

  3. Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy

    Ilaria Pergolini

Authors
  1. Florian Kuehn
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  2. Malte Weinrich
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  3. Sarah Ehmann
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  4. Katja Kloker
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  5. Ilaria Pergolini
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  6. Ernst Klar
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Contributions

Kuehn F analyzed and interpreted data and drafted the manuscript. Klar E and Weinrich M have done substantial contributions to conception and design of the study. Ehmann S has collected and analyzed data. Pergolini I helped to perform statistical analysis. Kloker K helped to collect and analyze data. Klar E has revised the article critically for important intellectual content; the article has been approved to be published by all authors.

Corresponding author

Correspondence to Florian Kuehn.

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The authors declare that they have no conflict of interest.

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Kuehn, F., Weinrich, M., Ehmann, S. et al. Defining the Need for Surgery in Small-Bowel Obstruction. J Gastrointest Surg 21, 1136–1141 (2017). https://doi.org/10.1007/s11605-017-3418-x

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  • DOI: https://doi.org/10.1007/s11605-017-3418-x

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