Gastrografin in A-SBO

Q: Diatrizoate meglumine-diatrizoate sodium, also known as Gastrografin (GGF) do all of the following in adhesive small bowel obstruction (ASBO) except? 

A) Predicts resolution of bowel obstruction without surgery 
B) Accelerates resolution of bowel obstruction 
C) Reduces the need for surgical intervention 
D) Reduces the length of stay (LOS) 
E) All of the above


Answer: C

It is important to understand the definition of adhesive small bowel obstruction (ASBO) to know the role of GGF in ASBO.  As the name implies, ASBO is any small bowel obstruction which occurs in a patient with a history of previous abdominal surgery causing adhesions and without any alternate explanation or cause for bowel obstruction, particularly hernia, malignancy, or inflammation. 

GGF is basically an oral water-soluble radiological contrast agent, which is used therapeutically in ASBO. It has a very high osmolarity. It moves the water into the small bowel lumen by osmosis, decreases the edema of the small bowel wall and consequently regenerates the peristalsis of the bowel, and so accelerates the resolution of ASBO (choice B). If it appears in the colon within 24 hours of its administration, it predicts the resolution of ASBO without surgery (choice A). But, it does not resolve the need for surgery in ASBO., if requires.

With its early effect, it helps in decreasing the LOS in the hospital (choice D).


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References / further reading:

1. Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 2007; :CD004651. 

2. Di Saverio S, Catena F, Ansaloni L, et al. Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg 2008; 32:2293. 

3. Burge J, Abbas SM, Roadley G, et al. Randomized controlled trial of Gastrografin in adhesive small bowel obstruction. ANZ J Surg 2005; 75:672. 

4. Ceresoli M, Coccolini F, Catena F, et al. Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg 2016; 211:1114. 

5. Farid M, Fikry A, El Nakeeb A, et al. Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO). J Surg Res 2010; 162:170.