An Analysis Of The Management And Outcomes Of Adhesive Small Bowel Obstruction

Background: Post-operative adhesions are the most common cause of small bowel obstruction and are a significant source of morbidity. Gastrografin is of diagnostic and therapeutic benefit. This study aims to review the local management and outcomes of adhesive small bowel obstruction (ASBO) and specifically the role of gastrografin. Methods: This retrospective cohort study was conducted between January 2020 to July 2021 at two regional hospitals in Kwazulu-Natal (KZN). All patients admitted with ASBO during the study period were included. Details regarding existing co-morbidities, number and type of previous surgeries and the clinical, radiological and biochemical findings on admission were collected. Outcome measures such as length of hospital stay, post procedural morbidities and mortalities were analysed. Results: Of the 77 patients admitted; 49 were male (64%) and 28 females (46%). The commonest previous surgery performed was laparotomy for appendicitis. Gastrografin was administered in 58 patients (77%) of which successful resolution of symptoms was seen in 24 patients (41%). Operative management (OM) was undertaken in 53 patients (67.5%). Significant predictive risk factors for OM included peritonitis (p =0.004); metabolic acidosis (p = 0.003) and the presence of feculent material in the nasogastric tube (NGT) (p = 0.0013). Conclusion: Peritonitis, metabolic acidosis and feculent effluent in the NGT was associated with an increased risk of surgery but did not predict the presence of ischemic bowel. Further study is warranted as this may save health care costs and reduce patient expenditure.