Contrast radiography in small bowel obstruction: a prospective, randomized trial

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Diagnostic Imaging

Background:

• Small bowel obstruction is a frequent cause of acute abdominal distress, leading to 20% of surgical emergency admissions.
• Current diagnostic methods lack reliability in identifying patients requiring surgical intervention for small bowel obstruction.
• Surgeons express hesitation regarding barium contrast studies due to potential complications, despite their diagnostic potential.

Purpose of the Study:

• To compare the efficacy of immediate oral barium contrast studies versus plain abdominal X-rays in patients with suspected small bowel obstruction.
• To evaluate diagnostic accuracy, time to resolution or operation, hospital stay, and morbidity associated with each imaging modality.

Main Methods:

• A randomized, prospective trial involving 64 patients presenting with signs and symptoms of small bowel obstruction.
• Patients were assigned to either immediate oral barium contrast studies (n=23) or plain abdominal radiographs (n=41).
• Outcomes measured included time to symptom resolution or surgery, total hospital days, and complications.

Main Results:

• Barium contrast studies demonstrated 100% sensitivity for complete obstruction, compared to 82% for serial plain radiographs.
• No complications were reported following oral barium administration.
• Time to operation was numerically shorter in the contrast group (8.2 hours) versus the plain radiograph group (12.4 hours), though not statistically significant (p=0.25).

Conclusions:

• Oral barium contrast studies are a safe and effective diagnostic tool for small bowel obstruction.
• Barium studies offer superior sensitivity in diagnosing complete obstruction compared to plain radiographs.
• The use of barium contrast studies may potentially expedite surgical intervention in select patients.