Small bowel obstruction (SBO) due to adhesions is managed initially non-operatively in 75–80% of cases. A water-soluble contrast follow-through (Gastrografin challenge) is used diagnostically and therapeutically. The therapeutic benefit (shortening hospital stay) was demonstrated in which RCT?

• A Multiple RCTs and meta-analyses show Gastrografin reduces need for surgery and shortens hospital stay in adhesive SBO ✓
• B Gastrografin has only diagnostic benefit; no therapeutic reduction in operative rate has been demonstrated
• C The Biondo et al. RCT showed Gastrografin significantly reduced time to resolution and operative rate
• D Gastrografin is only beneficial in colonic obstruction, not small bowel obstruction

Explanation

Multiple RCTs (Di Saverio et al., Assalia et al.) and subsequent Cochrane meta-analyses have confirmed that Gastrografin (water-soluble contrast) challenge in adhesive SBO significantly reduces the rate of operative intervention (by approximately 50% in non-resolving SBO) and shortens hospital stay. The hypertonic osmotic effect of Gastrografin also reduces bowel wall oedema and stimulates peristalsis. Contrast reaching the colon within 24 hours predicts resolution without surgery with ~97% positive predictive value.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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