The use of water-soluble contrast in evaluating clinically equivocal smallbowel obstructions

This study seeks to determine whether a 6-hour abdominal radiograph after o ral Gastrografin is a reliable indicator for nonoperative treatment in pati ents with a clinically equivocal small bowel obstruction. We collected retr ospective data from medical records. Patients who received a Gastrografin t ransit time (GGTT) study between January 1995 and September 1998 were inclu ded in the study. Patients who did not appear to be obvious operative candi dates, but had signs of intestinal obstruction, underwent a GGTT study. Ser ial plain abdominal radiographs were taken. If the contrast was in the colo n within 6 hours, then the result was negative. A total of 418 GGTT studies were reviewed. Contrast reached the colon within 6 hours in 283 (68%) pati ents, and 247 (88%) of these patients were managed nonoperatively. The posi tive predictive value, negative predictive value, sensitivity, and specific ity of Gastrografin reaching the colon within 6 hours were 48, 87, 64, and 78, respectively. False negatives included high-grade partial obstructions that ultimately required surgery. Recent operation preceded the GGTT in 128 (31%) cases. Of these 128 patients, only 17 (14%) received an operation. A lthough the decision to operate or not should never be based on a GGTT stud y alone, GGTT studies are of significant help in the clinical management of patients suspected to have a small bowel obstruction. GGTT allows for the judicious selection of the appropriate patient for nonoperative management. GGTT studies are cost effective, safe, and clinically useful when attempti ng to treat patients conservatively.