Effectiveness of Using Low-osmolarity Water-soluble Contrast in the Evaluation of Intestinal Obstruction With Conservative Management.

Abstract

Abstract INTRODUCTION: Intestinal occlusion represents a frequent cause of medical attention in the emergency department, within the current management guidelines it is well established that conservative treatment should be used as the first option. Gastrograffin® has been recommended to be used as a contrast agent as a predictor of successful conservative management; however, it is not usually available for use in public hospitals in our country. OBJECTIVE: To determine whether oral low-osmolarity water-soluble contrast (LOWS) is useful in identifying patients with bowel obstruction who will have a good response with conservative management. MATERIAL AND METHODS: Prospective, non-randomized, cohort study conducted in patients over 18 years of age, who presented with a diagnosis of intestinal obstruction. A nasogastric tube was placed for gastric emptying and intestinal decompression. After 6 hours, improvement was assessed by the decrease in nasogastric tube output and contrast medium was administered. Bolus LOWS 50cc were used and followed up radiologically. Surgical management was considered lacking contrast 24 hours after administration. RESULTS: In 41 cases we observed adequate passage of contrast and in 7 cases it did not reach the colon, in which case surgical exploration was indicated. Of the 41 patients with adequate clearance, 7 underwent surgery because of continued symptomatology. A PPV of 100% and NPV of 82.92% were calculated. The rate of complications is closely related to the need for surgical intervention, the degree of contamination of the abdominal cavity and hospital stay, there were no adverse events associated with the use of LOWS.