This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction

One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial.

We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were <18 years of age. The primary variable for analysis was the subsets of patients who were placed on our protocol versus no protocol at the other hospital. The primary outcome was hospital length of stay. Secondary outcomes included rate of surgery during the same admission and readmission within 30 days of discharge. All analyses were performed using Fisher's Exact test of Mann-Whitney U Test, as appropriate.

A total of 1302 patients with partial small bowel obstruction were identified (103 on-protocol and 1199 off-protocol at our sister hospital). On-protocol patients had a shorter duration of hospitalization (mean, 4.9 days vs. 6.0 days, p < 0.001), lower rates of surgery (2% vs. 16%, p < 0.001), and similar rates of readmission for the same diagnosis (8% and 5%, p = 0.26), compared to off-protocol patients at our sister institution.

A protocol utilizing Gastrografin for the management of partial small bowel obstruction decreases the need for surgery and shortens a patient's length of stay in a diverse community setting.