Management of small bowel obstruction and the use of contrast media: a prospective observational cohort study

Background and Objectives: Small bowel obstruction (SBO) is a typical surgical emergency that general surgeons handle, and it is associated with substantial healthcare costs. Of the SBOs, 60–75% are caused by adhesions from previous abdominal/pelvic surgeries. The Bologna guidelines recommend using water-soluble contrast media in cases of uncomplicated SBO. However, despite numerous research papers on the subject, the therapeutic role of contrast media (CM) is not universally agreed upon, and there is no unified protocol to guide the CM challenge. There is no consensus on the timing of CM administration nor the number and timing of radiographs taken. The decision regarding whom and when to operate remains a question for the on-call surgeons. Materials and Methods: The data of patients admitted for mechanical SBO in two regional hospitals in Estonia between May 2021 and April 2022 were documented. Data were collected prospectively and analyzed retrospectively. All patients participating in the study provided informed consent. We included patients with adhesive SBO and virgin abdomen in further analysis. We compared the data of patients who underwent surgery with that of patients whose SBO was resolved by conservative measures. Results: In 1 year, 213 patients with mechanical SBO were hospitalized. Of the 153 patients included in the study, 44 (28.8%) required surgical treatment, while the remaining 109 (71.2%) were managed successfully with conservative measures. Immediate surgery (within 6 hours of admission) was performed in 24 cases, and in 20 cases where conservative management was unsuccessful, surgery was opted for. The need for bowel resection varied between groups: 14 (58.3%) cases in the immediate surgery group compared to 3 (15%) cases after unsuccessful conservative treatment. Among the patients successfully treated conservatively, 53 (48.6%) had a history of previous SBO episodes. CM is used in the treatment algorithm, but the timing of its administration varies considerably (from 1 to 60 h). We did not find a statistically significant difference in the success of conservative management when comparing the timing of CM administration to no administration at all. Conclusions: We did not find conclusive evidence of the therapeutic effect of CM on SBO. Patients with a history of previous SBO and a higher number of previous abdominal operations were more likely to be managed by conservative measures.