Deconstructing Dogma: Non-Operative Management of Small Bowel Obstruction in the Virgin Abdomen

Purpose: Management of small bowel obstruction (SBO) has become more conservative, especially in those patients with previous abdominal surgery (PAS). However, surgical dogma continues to recommend operative exploration for SBO with no PAS. With the increased use of CT imaging resulting in more SBO diagnoses, it is important to reevaluate the role of mandatory operative exploration. Gastrografin administration decreases the need for operative exploration and may be an option for SBO without PAS. We hypothesized that the use of GG for SBO without PAS will be equally effective in reducing the operative exploration rate compared to that for SBO with PAS. Methods: A post-hoc analysis of prospectively collected data was conducted for patients with SBO from February 2015 through December 2016. Patients Results: Overall, 601 patients with SBO were included in the study, 500 with PAS and 101 patients without PAS. The two groups were similar except for age, gender, prior abdominal surgery including colon surgery, prior SBO admission and history of cancer. Multivariate analysis showed that PAS (OR = 0.47, p=0.03) and the use of GG (OR = 0.11, p Conclusion: Patients with and without PAS who received GG had lower rates of operative exploration for SBO compared to those that did not receive GG. Patients with a diagnosis of SBO without PAS should be considered for the non-operative management approach using GG.