A PROSPECTIVE-STUDY ON THE USE OF WATER-SOLUBLE CONTRAST FOLLOW-THROUGH RADIOLOGY IN THE MANAGEMENT OF SMALL-BOWEL OBSTRUCTION

Background: The purpose of this prospective study was to determine the value of water-soluble contrast follow-through radiology in predictin g the outcome in patients with small bowel obstruction. Methods: Patie nts with clinical and radiological evidence of small bowel obstruction were selected according to pre-set criteria. A water-soluble contrast follow-through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as 'significan t obstruction' if the contrast failed to reach the caecum in 4 h or if there was a clear cut-off in the gastrointestinal tract. The result w as interpreted as 'insignificant obstruction' if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the co ntrast examination in the patient management, and the decision to oper ate was based entirely on conventional clinical grounds. Results. Fift y-one patients in an 18 month period underwent the contrast examinatio ns. Thirty-four patients (67%) had had previous abdominal operations. The results showed that significantly more patients who had 'significa nt obstruction' on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had 'insignificant obstr uction' (1/32, Fisher's exact test, P < 0.0001). This difference was f ound to be significant in both patient subgroups: patients with or wit hout previous abdominal operation. There was no major morbidity or mor tality related to the contrast radiology procedure.Conclusions: Urogra fin follow-through examination is a safe procedure; using 4 h as the c ut-off it is highly predictive of the outcome in small bowel obstructi on in patients with or without previous abdominal operation.