This prospective randomized control study was conducted at the General Surgery Department of Suez Canal University Hospital between March 2015 and March 2016.
patients with clinical(history of abdominal operations > 6 weeks, abdominal pain, vomiting, abdominal distention and constipation) and radiological(erect and supine abdominal x-ray show multiple air fluid level) evidence of adhesive intestinal obstruction over 18 years were included in the study.
the following Patients were excluded.
Patients with peritonitis, signs of strangulation or with irreducible hernia
Patients with grossly dilated small gut > 10 cm in transverse diameter on abdominal x ray.
Patients with terminal malignancy or carcinomatosis peritoni.
Contraindiction for contrast administration (allergy).
Sample size: The sample size was determined by using the following equation: n = (z/e) 2p (100 − p) (19), where p is the incidence of the adhesive small bowel obstruction among acute abdomen presentation (25%), Za/2 is the percentile of standard normal distribution determined by 90% confidence level (1.96), and e is the width of the confidence interval (10%). The calculated sample size is 54 patients.
Patients were subjected to the following:
Full medical history including personal data, history of any medical illness, onset and duration of symptoms, previous operations, site of incision, time of operation, type of pathology (cause), usage of drainage, elective or emergent operation, mild or moderate complications (e.g., wound sepsis, delayed healing, and/or wound dehiscence), and severe complications (e.g., burst abdomen, fecal fistula, foreign bodies, and/or anastomotic dehiscence).
Complete clinical examination including general and local abdominal examination (abdominal distention, intestinal sound, abdominal scar, hernia, rigidity and guarding).
Laboratory workup including complete blood count, prothrombin time, partial thromboplastin time, serum electrolytes, and creatinine.
Imaging workup including erect chest X-ray excluding perforated viscus (air under the diaphragm), Erect abdominal X-ray to determine air-fluid levels (more than three diagnoses for intestinal obstruction), Supine abdominal X-ray to determine the site of obstruction and CT scans to determine the cause of obstruction.
Patients included in the study were admitted to the surgical ward. Gastric decompression was performed with the placement of a nasogastric tube then 100 mL of 76% gastrografin water-soluble contrast was injected slowly through the nasogastric tube and follow-up erect, supine abdominal X-rays were done at 8, 12, and 24 h. The post contrast x-ray was reviewed by single radiologist. The result was interpreted as (1) significant obstruction if the contrast failed to reach colon and/or if there is clear cut-off of the contrast in the gastrointestinal tract (2) insignificant obstruction if the contrast reaches the colon. The decision to operate was based on clinical and radiological grounds and patients were operated on if there was: (1) deterioration in clinical signs (2) no progress in symptoms and signs of intestinal obstruction for 48 h from start of conservative management.
Time was allowed for resuscitation and for conservative treatment in the event that adhesive obstruction would resolve spontaneously and emergency operation to be avoided. The final outcome of the patients (surgery or no surgery) and the contrast examination results were reviewed after the patient were discharged from hospital.
The gathered data were processed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). Quantitative and qualitative data were expressed as means ± SD and numbers and percentages, respectively. Moreover, Student's t-test and chi-square test were used to test the significance of the difference for quantitative and qualitative variables, respectively. A p < 0.05 was considered statistically significant. In addition, written informed consent was obtained from the patients or patients' relatives before study inclusion.