1 results for Abbas, Saleh

  • The role of water-soluble contrast in the management of adhesive small bowel obstruction

    Abbas, Saleh (2013)

    Doctoral thesis
    The University of Auckland Library

    Adhesions are the most common cause of small bowel obstruction (SBO) in western countries. Ninety-three per cent of adhesions are caused by a previous abdominal operation. They are particularly common after colorectal resection and ileal-anal pouch reconstruction. In recent years water soluble media have been demonstrated to help in the diagnosis of bowel obstruction and also in predicting the likely success of nonoperative resolution. Some authors have also suggested a therapeutic value for water-soluble contrast. This aim of this thesis is to investigate the role of water-soluble contrast media in the management of adhesive SBO. An attempt to quantify the burden of adhesive SBO in New Zealand was made by retrospectively reviewing the experience at a major teaching hospital. This was followed by a systematic review and meta-analysis of the published literature. A randomised controlled trial to evaluate the therapeutic role of water-soluble contrast (Gastrografin) in adhesive SBO was then conducted. This was followed by assessment of the impact of routine use of Gastrografin on the management of adhesive SBO. The retrospective review showed that the New Zealand experience is similar to that overseas. The systematic review showed that Oral administration of Gastrografin was safe and when followed by abdominal X-ray helps to triage patients to surgical and no-operative management. It also suggested a therapeutic role in this setting. The randomised controlled trail confirmed that Gastrografin has therapeutic value in adhesive SBO. The final study showed that the routine administration of Gastrografin did not shorten hospital stay probably related to significant breaches of protocol. In conclusion, SBO is a common problem. Gastrografin has an important triage role and hastens resolution of SBO. If Gastrografin is to make an overall difference to SBO management in a hospital then breaches in protocol need to be addressed.

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