A 50-year-old woman with a previous midline laparotomy presents with colicky abdominal pain, absolute constipation for 18 hours, and bilious vomiting. CT shows small bowel loops dilated to 4.5 cm with a transition point in the mid-ileum. She has no peritonism. After nasogastric tube insertion, her pain and vomiting improve. What is the most appropriate management?
- A Immediate laparotomy to release the adhesion
- B Total parenteral nutrition and conservative management for 5 days
- C CT with water-soluble oral contrast (Gastrografin challenge) ✓
- D Laparoscopic adhesiolysis within 24 hours
Explanation
Gastrografin (water-soluble contrast) challenge is a diagnostic and therapeutic tool for adhesive small bowel obstruction (SBO): if contrast reaches the colon within 4–8 hours on follow-up X-ray, resolution without surgery is predicted with >90% accuracy. Gastrografin also has a therapeutic osmotic effect that may accelerate resolution. The Bologna guidelines recommend non-operative management with Gastrografin challenge for adhesive SBO without strangulation signs. Immediate surgery is indicated only for strangulation, peritonitis, or failed conservative management beyond 48–72 hours.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.