[size=20px]A 10 year old boy with a history of ileal atresia repair as an infant presents to the emergency department with a 2 day history of abdominal pain and emesis. The child was well prior to the onset of symptoms. He has not had fever or sick contacts. He does not report ever having similar symptoms. Plain abdominal x-rays reveal concern for a partial small bowel obstruction. Which of the following may decrease this child length of stay and need for operative intervention?

 

A Gastrografin challenge

 

B Barium enema

 

C Early enteral feeding

 

D Avoidance of nasogastric decompression

 

E CT scan with IV contrast

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A

Gastrografin challenge

A

A , gastrografin

A

A

A Gastrografin challenge

Electrolyte imbalance

Gastro graffin challenge

Cect

Correct answer

A Gastrografin challenge

 

Adhesive small bowel obstruction remains a significant cause of morbidity. Conservative management with gastric decompression has been the mainstay of treatment in multiple studies. There have been a number of adult studies evaluating the use of the “gastrografin challenge” in the management of small bowel obstruction. A 2017 article from the Eastern Association of Trauma Small Bowel Obstruction study group evaluation of 316 patients showed lower rates of exploration and shorter hospital length of stays in patients that received gastrografin. There have not been any large multi-institutional randomized controlled studies at this point.

 

Gastrografin may also benefit the patient in identifying a point of obstruction that is not likely to resolve with conservative management. Early identification and surgical intervention also leads to decreased lengths of stay in this patient population. Careful discussion with radiology is necessary to understand the dilution that occurs with passage through the small bowel. Children with signs of bowel ischemia, peritonitis, perforation, or worsening clinical status would not benefit from this approach.

 

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