WATER-SOLUBLE CONTRAST MATERIAL HAS NO THERAPEUTIC EFFECT ON POSTOPERATIVE SMALL-BOWEL OBSTRUCTION - RESULTS OF A PROSPECTIVE, RANDOMIZED CLINICAL-TRIAL

BACKGROUND: Hyperosmotic water-soluble contrast materials have been fo und to be helpful diagnostic tools in postoperative sma!l-bowel obstru ction (POSBO); however, their therapeutic value remains controversial. PATIENTS AND METHODS: A prospective, randomized clinical study was co nducted to examine the use of meglumine ioxitalamate as a supplement t o the standard conservative treatment of POSBO. Patients with POSBO (n = 50) suitable for a conservative approach were randomized to receive standard conservative treatment with (n 25) or without (n = 25) the a ddition of 100 mt of meglumine ioxitalamate via the nasogastric tube ( patients with diffuse carcinomatosis and early POSBO were,excluded). B oth groups were compared for resolution of obstruction, need for surgi cal relief of obstruction; and complications. RESULTS: Seven (14%) pat ients required surgery: 3 in the contrast material group and 4 in the control group (P = not significant [NS]). Resolution of symptoms was a chieved in nonsurgical patients within an average of 25.7 hours in the contrast material group and 28.7 hours in the control group (P = NS): There was no mortality in this study. In 2 (4%) patients (1 in each g roup), strangulated bowel was found during surgery; but only the 1 (2% ) patient in the contrast material group required bowel resection. No difference was found in the length of hospital stay or rate of complic ations. There were no complications that could be attributed to the us e of the contrast material itself, CONCLUSIONS: Although water-soluble contrast material is a safe and useful diagnostic tool, it offers no advantage as a supplement to the usual conservative treatment of POSBO .