Http://www.ncbi.nlm.nih.gov/pubmed/12131078, http://www.ncbi.nlm.nih.gov/pubmed/12734858, http://www.ncbi.nlm.nih.gov/pubmed/12734858
Most of the time good clinical history and examination is enough. But a quick CT abdomen with contrast will give you a better picture.
Thank you for your answers, I mostly wanted to pount out the therapeutic effect that gastrografin may have. is it a myth, or a fact? in the literature there are controversial results, in practise a lot of dogmas!
Thank you for the links to an unexpected aspect of gastrografin properties!
I'll try to answer by points:
1) Gastrografin gives X-ray images of less quality comparing to a barium sulfate suspension, so it should NOT to be used for the small bowel obstruction diagnostics without clinical signs of the acute peritonitis or strangulation.
2) CT seemingly does not have advantages over a plain film in upward position for the small bowel obstruction diagnostics as a routine method, but it has shortcomings taking more time and certain bulkiness to perform, by far higher a price.
3) CT may be more useful than X-ray in those patients who are not allowed to or impossible to change the posture due to heaviness of their general condition, etc. However, where CT is of the most needness for the acute abdominal disorders diagnostics, it cannot be usually used: in an instances of artificial breathing support, shock, and so on. Ultrasonographic scanning is a method of choice for the case.
As for the major part of your question, namely, pathophysiological site, one could speculate that the small bowel obsruction due to peritoneal adhesions may lead to the development of small intestinal overgrowth syndrome, the acutest one, which may affect the course of obstruction up to taking the dominate role in its progress and deteriorate the general condition of the patient (See my question: 'Does the intestinal microflora pattern change in the abdominal compartment syndrome due to peritonitis?' at ResearchGate)
So that I usually recommend to use parenteral wide-spectrum antibiotics in these cases, though they are not included in our national guidelines for the SI Obstruction management.
There might be a exclusion from general guidelines for the most dangerous and ungrateful form of the adhesional bowel obstruction, so-called 'Panzerbauch', the heaviest degree of the hostile abdomen (See Dr.Gerych paper) when the abdominal cavity as itself does not exist. These patients had had multiple interventions due to relapses of small bowel obstruction, there is the highest risque of the intestinal wall damage during operation, and there is the utmost probability of the chronic small intestine bacterial overgrowth syndrome they have and which may play the leading role in the onset of the obsruction recurrency.
At any rate, antiseptics of any kinds look promising from this point of view, and Gastrografin is antiseptics also, because it contains the iodine. However, Gastrografin should be tested experimentally, in vitro and in vivo as antimicrobial agent. From another hand, role of SIBO syndrome in SI obstruction pathophysiology warrants further... no, at least any investigation!
Plain film of abdomen followed by C T with oral and I V contrast is the best way to study to study the cases suspected small bowel obstruction.
I will tell nothing new, but just to put a point upon i:
To distinguish a complete and partial SB obstruction, simple criterium was developed. In case of colon pneumatization absence or disappearing in the course of contrast medium test, they say of 'the compete obstruction'. If colonic gas remains in spite of Kleuber cups presence, they say of 'the partial one'.That means by my humble opinion that the passage keeps on, and nutrient remnants flow into the colonic lumen where they ingest by the colonic microflora producing gases which one can detect on X-ray film, or, at advanced hospitals, in spiral CT.
Thank you all, for the intetesting discussion, answers and comments
Gastrografin and other soluble contrast may increase the bowel motility and help to treat incomplete mechanical obstruction, but at the same time they may absorb water from intravascular space to bowel lumen and cause hypovolemia in pediatric or old patients. so they should be used with meticulous attention to patients hydration status
The identification of a definite point of obstruction, the ‘transition zone’, with dilated small bowel loops proximal to the site of obstruction and collapsed loops distally, is the most reliable CT criterion for diagnosing small bowel obstruction .
I totally agree with the transition point. If you have it you will need to operate, this time or another moment, in a following episode. Βut, if you dont have it, maybe gastrografin helps resolution. with the risk of dehydration, as mentioned
There is another role gastrograffin may play in small bowel obstruction. use neat 100 cc gastrograffin and follow up with plain film of the abdomen in an hour. if the iliocecal junction has been crossed its very unlikely that the pt will go into surg during this episode …….
ref; pocket book; bookemergencies in clinical radiology, oxford.
It is limited to adhesive small bowel obstruction after up to 72 hrs of non operating management. It is unwise to give gastrograffin trial in an unscarred abdomen.
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