Management of small bowel obstruction and therapeutic role of contrast media: A multicenter study

Adhesive small bowel obstruction (SBO) accounts for 55-75% of mechanical small bowel obstructions [1,2]. According to guidelines, water-soluble contrast media (CM) is suggested in the diagnostic work-up of adhesive SBO [3], [4], [5]. However, there is currently no consensus on the therapeutic role of water-soluble CM in adhesive SBO [6] or a generally approved protocol as to when CM should be administered, how often should radiographs be taken and how long conservative management can safely be pursued.

The data of patients who were hospitalized for SBO in two regional hospitals of Estonia between January 2015 and December 2019 were retrospectively collected from the hospitals' electronic databases.

Of 1,008 patients with mechanical SBO included in analysis, 140 (13.9%) were operated on immediately. In the case of conservative management, 575 (66.2%) patients received CM. Resolution occurred in 75.8% of the patients who received CM and in 68.9% of the patients who did not (p = 0.037). Resolution rate was the highest (78.8%) in the group that received CM within 12 h of admission. The duration of symptoms was longer in patients who needed surgical intervention compared to conservatively treated patients (31 h vs 15 h, p<0.001). For patients with a history of a single previous abdominal/pelvic operation, the likelihood of surgical intervention was higher compared to patients whom resolution was achieved with conservative measures (50.9% vs 38.5%). In patients with three or more previous operations SBO resolved more often with conservative treatment compared to patients who required surgical intervention (22.7% vs 11.4%; p<0.001).

The significantly higher rate of SBO resolution in the CM group suggests that CM may have a therapeutic role in SBO treatment, especially when it is administered within 12 h of admission. Patients with longer duration of symptoms and a history of one previous abdominal surgery need more likely surgical treatment.