The value of contrast radiology for postoperative adhesive small bowel obstruction.

Background/aims: Contrast radiology predicts the outcome of treatment for patients with small bowel obstruction. The optimal method of contrast radiology to determine the indications for and timing of surgery is controversial.

Methodology: Contrast radiology was performed for patients with postoperative adhesive small bowel obstruction between April 1, 2000 and March 31, 2001. Nearly 40 mL of gastrografin mixed with 40 mL of water was administered either orally or via a nasogastric tube to each patient within 24 hours of hospital admission. Serial erect and supine plain abdominal radiographs were taken 4, 8, 16 and 24 hour later.

Results: Of 107 patients with postoperative adhesive small bowel obstruction, 97 patients had the examination completed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of this study as an indicator for non-operative treatment were 98.9%, 66.6%, 96.9%, 97.8% and 80%. However, contrast radiology had little impact on the diagnosis of 6 patients with strangulated small bowel obstruction. Ninety-two of 93 patients (98.9%) who were resolved with non-operative treatment were resolved within 48 hours of hospitalization.

Conclusions: Contrast radiology should be considered for patients with simple small bowel obstruction who did not improve with non-operative measures after 48 hours of hospitalization.