Obstruction reduction: Use of water-soluble contrast challenge to differentiate between partial and complete small bowel obstruction.

Autor: Moskowitz E; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, USA., Campion EM; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, USA. Electronic address: Eric.Campion@dhha.org., Burlew CC; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, USA., Helmkamp LJ; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, USA., Peltz ED; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA., Gansar BL; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA., McIntyre RC; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2019 Nov; Vol. 218 (5), pp. 913-917. Date of Electronic Publication: 2019 Feb 28.
DOI: 10.1016/j.amjsurg.2019.02.034
Abstrakt: Differentiating SBO that will resolve conservatively from those requiring surgery remains challenging. Water-soluble contrast administration may be diagnostic and therapeutic. Our study evaluated use of a WSC challenge protocol. We hypothesize that protocol use discriminates between surgical SBO and obstructions which can be managed non-operatively. Demographics, prior surgeries, time to operation, complications, and LOS were analyzed. 108 patients were admitted with SBO. 13% underwent immediate laparotomy with concern for bowel compromise; these had a median LOS of 8.5 days. 91 received WSC protocol. Of these, 77% had contrast passage to the colon. Of the 48 in whom contrast passed between 0 and 12 h, LOS was 2 days. Of the 22 patients in whom contrast passed between 12 and 24 h, LOS was 4.5 days. 21 had failure of contrast passage; 18 of those underwent surgery after 24 h as a result. Of the 21 patients who failed WSC challenge, median LOS was 8 days. WSC protocol implementation facilitates early recognition of partial from complete obstruction and may decrease LOS. Our findings warrant further evaluation with a multicenter trial.
(Copyright © 2019. Published by Elsevier Inc.)
Databáze: MEDLINE
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