TY - JOUR
T1 - Successful use of water-soluble contrast in patients with small bowel obstruction and virgin abdomen
T2 - A case report
AU - Figueiredo, Sergio Mazzola Poli de
AU - Demola, Sara
N1 - Publisher Copyright:
© 2021 The Author(s)
PY - 2021/2
Y1 - 2021/2
N2 - Introduction and importance: Nonoperative management of adhesive SBO is well established but remains a challenge in patients without prior abdominal surgery. We aim to report a case of successful nonoperative management with the use of enteral hypertonic water-soluble contrast administration in a patient with virgin abdomen. Case presentation: A healthy 24-year old man with no previous surgery presented to the emergency room with one day of abdominal pain. A CT abdomen and pelvis was consistent with SBO without clear anatomic etiology. The patient refused surgical intervention, so we performed a trial of nonoperative management. On hospital day 2, a repeat CT A/P with enterally administered water-soluble contrast showed resolution of SBO. The patient has had no symptoms since hospital discharge on 6 months follow up. Clinical discussion: Small bowel obstruction is most commonly secondary to adhesions from prior surgeries. Even in patients with virgin abdomen, adhesions are the cause of SBO in 53%–73%. Recent studies in patients with virgin abdomen showed that 92.1% that underwent nonoperative management did not have a recurrence of SBO with mean follow up of 4.5 years. The use of water-soluble contrast in patients with virgin abdomen was reported to have 92–97% success rate. A meta-analysis showed a pooled prevalence of 7.7% of malignant etiology of SBO in these patients, more common with previous SBO admission or history of malignancy. Conclusion: Nonoperative management with the therapeutic use of hypertonic water-soluble contrast is a viable treatment option in select cases and avoids the morbidity of surgical exploration.
AB - Introduction and importance: Nonoperative management of adhesive SBO is well established but remains a challenge in patients without prior abdominal surgery. We aim to report a case of successful nonoperative management with the use of enteral hypertonic water-soluble contrast administration in a patient with virgin abdomen. Case presentation: A healthy 24-year old man with no previous surgery presented to the emergency room with one day of abdominal pain. A CT abdomen and pelvis was consistent with SBO without clear anatomic etiology. The patient refused surgical intervention, so we performed a trial of nonoperative management. On hospital day 2, a repeat CT A/P with enterally administered water-soluble contrast showed resolution of SBO. The patient has had no symptoms since hospital discharge on 6 months follow up. Clinical discussion: Small bowel obstruction is most commonly secondary to adhesions from prior surgeries. Even in patients with virgin abdomen, adhesions are the cause of SBO in 53%–73%. Recent studies in patients with virgin abdomen showed that 92.1% that underwent nonoperative management did not have a recurrence of SBO with mean follow up of 4.5 years. The use of water-soluble contrast in patients with virgin abdomen was reported to have 92–97% success rate. A meta-analysis showed a pooled prevalence of 7.7% of malignant etiology of SBO in these patients, more common with previous SBO admission or history of malignancy. Conclusion: Nonoperative management with the therapeutic use of hypertonic water-soluble contrast is a viable treatment option in select cases and avoids the morbidity of surgical exploration.
KW - Adhesions
KW - Case report
KW - Nonoperative management
KW - Small bowel obstruction
KW - Virgin abdomen
KW - Water soluble contrast
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U2 - 10.1016/j.ijscr.2021.01.004
DO - 10.1016/j.ijscr.2021.01.004
M3 - Article
AN - SCOPUS:85099315472
SN - 2210-2612
VL - 79
SP - 94
EP - 96
JO - International Journal of Surgery Case Reports
JF - International Journal of Surgery Case Reports
ER -