TPW 2.16 Clinical Predictors of Non-Resolution after Gastrografin Challenge in Adhesional Small Bowel Obstruction

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ID: 324101
2026
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Abstract
Abstract Aims Band adhesions remain the leading cause of small bowel obstruction (SBO) in adults. Non-operative management is the initial approach and succeeds in most cases. Gastrografin (Diatrizoate), a water-soluble contrast medium, aids resolution through its osmotic effect on the bowel. The aim of this study is to assess Gastrografin’s effectiveness and predictors of non-resolution in adhesional SBO. Methods This retrospective study, conducted at Mid and South Essex NHS Foundation Trust (January 2020–December 2024), included patients ≥ 16 years with CT-confirmed adhesional SBO who received 100 ml Gastrografin (orally or via nasogastric tube), followed by abdominal X-ray at 12 hours. Exclusions included non-adhesional causes of SBO, Gastrografin given only for diagnosis, contraindications to non-operative management, and incomplete data. Results A total of 271 patients (median age 74 years; 139 males, 132 females) were analysed. Median hospital stay was 10 days (range 0–159), with mean Charlson Comorbidity Index of 5.9. Adhesions were linked to prior colorectal surgery (41.0%), gynaecological surgery (10.7%), or no documented prior surgery (24.0%); 21.0% had previous SBO admissions. Contrast reached the colon in 59.4%, and clinical resolution occurred in 64.9%. Of 95 non-resolvers, 77.9% required surgery (26.3% with bowel resection). Only 10.5% of failures had prior SBO admissions, while 70.5% showed no colonic contrast at 12 hours. Conclusions Age, Charlson Comorbidity Index, and previous SBO admissions did not predict success. However, absence of contrast in the colon on X-ray 12 hours post-Gastrografin administration was a strong predictor of non-resolution and likely need for operative intervention.
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Authors Andrew Chiagozie Ekwesianya, Jessie Abernethy, Wan Ko, Hayah Faridi, Wing Yan Chan, Abraham Ayantunde
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.314
URL
https://doi.org/10.1093/bjs/znag087.314
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