Contrast transit time for small bowel obstruction: does it matter?

The widespread implementation of standardised protocols, specifically nasogastric tube (NGT) decompression and gastrografin-based small bowel follow-through (SBFT), has enhanced clinical outcomes in adhesive small bowel obstruction (SBO). Nonetheless, a clinical challenge arises when a subset of patients demonstrates obstruction resolution on SBFT but fails subsequent diet advancement, resulting in prolonged hospitalisation. This study sought to identify patient characteristics or imaging markers early in the clinical course that predict the need for operative intervention in partial small bowel obstruction (pSBO).

This is a retrospective, single-institution, multihospital review of outcomes in 110 patients who presented with SBO and passed a SBFT study. Patients with adhesive SBO on initial imaging who passed SBFT were categorised by surgical status and by SBFT transit time. Patient characteristics collected included demographic information, medical and surgical history, laboratory values and imaging findings.

When the operative and nonoperative groups were compared, significant differences were detected in sex, NGT insertion, median number of gynecologic surgeries, and length of hospitalisation. However, none of these characteristics increased the risk of surgical intervention on multivariate logistic regression analysis. Only a contrast transit time exceeding 12 hours significantly increased the risk of requiring surgery (p<0.001).

A contrast transit time exceeding 12 hours on SBFT was independently associated with a significantly increased risk of surgical intervention. As literature on contrast transit time and surgical outcome in SBO remains scarce, a 12-hour cutoff may help clinicians identify patients with pSBO who are more likely to require earlier operative intervention.