Iohexol in the management Small Bowel Obstruction

Author(s): Nirmal Kaanth C, Pradeep Kumar S, Rajath Kumar

Introduction: Despite progress in surgical techniques and perioperative care, small bowel obstruction (SBO) and postoperative ileus (POI) continued to be common consequences of abdominal surgery. These conditions often led to prolonged hospital stays, increased medical expenses, and frustration for both patients and surgeons. The adoption of nonoperative measures, such as the use of oral water-soluble contrast agents, signified a significant advancement in the management of patients experiencing postoperative small bowel obstruction.

Patients and Methods: A study was carried out at the Department of Surgery ESIC Medical College and PGIMSR involving 105 adults. The study centered on individuals presenting with clinical and radiologic indications of small bowel obstruction. Data collection occurred from March 2022 to November 2023, spanning a period of 21 months.

Results: Seventy-eight percent of patients who presented to the emergency department with symptoms of adhesive small bowel obstruction (SBO) initially underwent nonoperative management with iohexol. This approach resulted in reduced hospital stays, a decreased need for surgery, and earlier recovery. Among them, 18% ultimately required surgery.

Conclusion: Sixty-six percent of the patients underwent a successful oral water-soluble contrast (OWSC) challenge. This approach proved to be a valuable strategy for hastening the decision-making process in the management of adhesive small bowel obstruction (SBO). It was associated with a low estimated risk of late small bowel resection for ischemia, reported at approximately 0.2% in the study.