Impact of a Standardized Gastrografin Protocol on Small Bowel Obstruction Outcomes at a Community Hospital: A Retrospective and Prospective Cohort Study

Small bowel obstruction (SBO) is a common condition in general surgical practice. This study aimed to determine whether the use of an oral hyperosmolar contrast agent (Gastrografin) combined with serial abdominal radiographs improves patient outcomes compared with standard management of SBO in a community hospital. A retrospective and prospective analysis was conducted of patients admitted with SBO over a two-year period. The retrospective control group included patients from January 2022 through December 2022, while the prospective group included those from January 2023 through December 2023. Exclusion criteria were emergent operative intervention, recent abdominal surgery (<30 days), and age <18 years. Patients treated with a standardized Gastrografin protocol were compared with those managed conventionally. Primary outcomes included length of stay (LOS), number of CT scans, progression to surgery, and 30-day readmission rates. Ninety patients met the inclusion criteria; 24 received the Gastrografin protocol, and 66 received standard care. The Gastrografin group had a significantly shorter LOS (2.2 ± 1.4 vs. 4.6 ± 4.2 days, p < 0.001) and underwent fewer CT scans (1.0 ± 0.0 vs. 1.4 ± 0.6, p < 0.001). Rates of surgical intervention (4.2% vs. 21.2%, p = 0.06) and 30-day readmission (12.5% vs. 15.2%, p = 1.00) did not differ significantly between groups. The findings suggest that a standardized Gastrografin protocol may reduce hospital LOS and CT utilization in the management of SBO at community hospitals.