Pre-operative Decision Making in Adhesive Small Bowel Obstructions

The goal of this paper was to evaluate contemporary trends in the work-up and management of adhesive small bowel obstructions (ASBOs). The water-soluble contrast challenge (WSCC) has become the standard of care for differentiating non-operative from operative ASBOs, however there is significant variability among institutions regarding the timing of nasogastric decompression before initiating the study as well as the amount of contrast to be used and the length of time that should be allowed to pass before it is decided that a patient has “failed” the WSCC.

The latest findings include evidence that the duration of nasogastric decompression necessary to perform a WSCC may be as short as two hours, however most institutions still practice a longer decompression period. We also present data that suggests that while the original Bologna guidelines suggested a safe window of non-operative management between three and five days for the WSCC to occur, it is possible that those patients who take over eight hours of contrast transit time to pass the WSCC have a higher likelihood of one-year ASBO recurrence and should be considered for operative intervention, even if contrast eventually makes it to their colon.

We offer an evidence-based standardized approach to administering the WSCC.