Postoperative ileus on a gynecologic oncology service--do abdominal X-rays have a role?

The objective was to estimate the role of abdominal radiographs in the management of the patient with gastrointestinal dysfunction in the early postoperative period following intra-abdominal gynecologic surgery.

Hospital records were reviewed for 84 patients from the gynecologic oncology service having a clinical diagnosis of either ileus or bowel obstruction immediately after intra-abdominal gynecologic surgery. Patient history, clinical signs and symptoms, findings of plain radiographs, and clinical course were studied to determine whether plain abdominal radiographs were useful in the management of these patients.

At least one set of abdominal X-rays was obtained for 56 (66.7%) patients, of which 24 (42.9%) were considered radiographically diagnostic. A lower preoperative American Society of Anesthesiologists (ASA) physical status score correlated with a greater likelihood of having abdominal films (P = 0.005). No single clinical finding correlated with either the decision to obtain films or X-ray diagnosis of ileus or bowel obstruction. Use of any nonsurgical treatment modality was not significantly different for patients who had films versus those who did not. Mean length of hospital stay was significantly prolonged for patients who had abdominal X-rays. Seven patients were subjected to reoperation; however, no association was found between X-ray diagnosis of ileus or bowel obstruction and the need for reoperation.

Plain abdominal radiographs have little clinical utility in the evaluation of patients with gastrointestinal dysfunction in the early postoperative period following intra-abdominal gynecologic surgery. Diagnostic studies such as CT scanning or a GI contrast study may be more helpful in the management of these patients.