# Adhesive Small Bowel Obstruction — GCMD Library living collection

Everything in the library about adhesive small bowel obstruction — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 61 cited statements

## Episodes
### Medical Management
- [Gastrografin Protocol for Adhesive Small Bowel Obstruction (SBO)](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713) — video · [machine version](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713.md)

### Evidence & Research
- [Best of the Best APSA Winner](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349) — video · 9:46 · [machine version](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349.md)
- [APSA - A contrast challenge is safe in children with adhesive small bowel obstruction- a multi-institutional review - Nathan Rubalcava](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366) — video · 8:44 · [machine version](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=0) Introduction and Background on Gastrografin for Adhesive SBO (Ep 1)
- [1:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=60) Literature Basis and Protocol Development (Ep 1)
- [2:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=120) Patient Selection Criteria and Exclusions (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=180) Initial Management and Gastrografin Administration (Ep 1)
- [4:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=240) Imaging Follow-up and Decision Points (Ep 1)
- [5:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=300) Monitoring Requirements and Outcomes (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=0) Introduction to Best of the Best Competition and APSA Presentation (Ep 2)
- [1:33](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=93) Study Presentation: Safety of Contrast Challenges in Pediatric Adhesive Small Bowel Obstruction (Ep 2)
- [5:59](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=359) Discussion: Protocol Variation and Clinical Adoption (Ep 2)
- [8:50](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=530) Closing Remarks on Clinical Impact (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=0) Introduction and session setup (Ep 3)
- [0:33](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=33) Study presentation: contrast challenge safety and efficacy (Ep 3)
- [4:57](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=297) Discussion: protocol variation and adoption barriers (Ep 3)
- [7:48](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=468) Closing remarks on clinical impact (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery." — Nate Rubocava (clinical) [Ep 2 · 1:33](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=93)
- "Traditional treatment for adhesive small bowel obstruction has been gastric decompression, bowel rest, fluid resuscitation, and electrolyte replacement." — Nate Rubocava (clinical) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=110)
- "Over the last two decades, water-soluble contrast agents in management of small bowel obstructions have become well established in adult literature given their ability to predict success of non-operative management." — Nate Rubocava (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=125)
- "In the contrast challenge protocol, after gastric decompression the patient is given contrast and an abdominal X-ray is obtained 8 to 10 hours later. Contrast in the colon indicates passing the challenge." — Nate Rubocava (clinical) [Ep 2 · 2:25](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=145)
- "Patients without contrast in colon after repeat X-ray at 24 hours are considered to have failed the contrast challenge and are taken to surgery for exploration." — Nate Rubocava (clinical) [Ep 2 · 2:55](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=175)
- "Limited data exists regarding safety and use of contrast challenge in the pediatric population, yet multiple pediatric institutions have adopted contrast challenge algorithms." — Nate Rubocava (epidemiological) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=195)
- "The study performed retrospective review of all children undergoing contrast challenge across 5 children's hospitals over 8 years." — Nate Rubocava (clinical) [Ep 2 · 3:45](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=225)
- "Primary outcome was any complication related to contrast administration, with complication rate less than 5% considered safe for clinical practice by group consensus." — Nate Rubocava (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=240)
- "Major complications were defined as aspiration, pneumonia, anaphylaxis, cardiovascular complications, and renal failure. Minor complications included urticaria, dyspnea, and worsening abdominal pain." — Nate Rubocava (clinical) [Ep 2 · 4:20](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=260)
- "82 children underwent contrast challenge. 57 initially passed, of which 53 had clinical improvement and were successfully discharged. 25 failed and were taken to surgery." — Nate Rubocava (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=280)
- "There was significant age difference between groups, with those passing the challenge a median of 7 years older, but no differences between each age group." — Nate Rubocava (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=300)
- "Over 30% of patients had neurologic and pulmonary comorbidities." — Nate Rubocava (epidemiological) [Ep 2 · 5:15](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=315)
- "Contrast agents used were institution-specific with relatively similar osmolality, with dilute gastrographin being most commonly utilized." — Nate Rubocava (clinical) [Ep 2 · 5:25](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=325)
- "There were no major or minor complications in the study, with 0% complication rate and confidence interval of 0 to 3.6%, significantly below the pre-set acceptable rate of 5%." — Nate Rubocava (clinical) [Ep 2 · 5:40](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=340)
- "There were no mortalities in either group." — Nate Rubocava (clinical) [Ep 2 · 5:55](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=355)
- "The group that failed contrast challenge had significantly longer hospital stay by 5 days." — Nate Rubocava (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=280)
- "6 patients were readmitted within 30 days for recurrent small bowel obstruction." — Nate Rubocava (clinical) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=295)
- "The contrast challenge has sensitivity of 100%, specificity of 86%, negative predictive value of 100%, and positive predictive value of 93%." — Nate Rubocava (clinical) [Ep 2 · 5:05](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=305)
- "This review of 82 patients is the largest to date in children demonstrating that contrast challenge is safe, effective, and highly predictive." — Nate Rubocava (clinical) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=330)
- "Every institution had similar protocol that had been mirrored to Dr. Grace Mack from University of Chicago's study from 2018." — Nate Rubocava (clinical) [Ep 2 · 6:59](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=419)
- "The Midwest Pediatric Surgery Consortium is conducting a prospective study looking at contrast challenges in pediatric adhesive small bowel obstruction." — Nate Rubocava (clinical) [Ep 2 · 7:25](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=445)
- "More pediatric surgeons have adopted the practice after seeing it was safe and effective in predicting which children will be successfully managed non-operatively." — Nate Rubocava (opinion) [Ep 2 · 7:55](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=475)
- "This contrast challenge will positively impact management of every child that undergoes abdominal surgery because they are at risk of adhesive small bowel obstruction for the rest of their life." (opinion) [Ep 2 · 9:06](https://library.globalcastmd.com/watch/best-of-the-best-apsa-winner-5349?t=546)
- "Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery" — Nate Rubocava (clinical) [Ep 3 · 0:33](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=33)
- "Traditional treatment for adhesive small bowel obstruction has been gastric decompression, bowel rest, fluid resuscitation, and electrolyte replacement" — Nate Rubocava (clinical) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=60)
- "Over the last two decades, water-soluble contrast agents in management of small bowel obstructions have become well established in adult literature given their ability to predict success of non-operative management" — Nate Rubocava (clinical) [Ep 3 · 1:20](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=80)
- "A contrast challenge is performed after a period of gastric decompression, with abdominal X-ray obtained 8 to 10 hours after contrast administration" — Nate Rubocava (clinical) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=105)
- "Contrast in the colon is considered having passed the contrast challenge, and patients are discharged after demonstrating clinical improvement with tolerance of regular diet" — Nate Rubocava (clinical) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=130)
- "Patients without contrast in colon after repeat abdominal X-ray at 24 hours are considered to have failed their contrast challenge and are taken to surgery for exploration" — Nate Rubocava (clinical) [Ep 3 · 2:30](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=150)
- "Limited data exists regarding safety and use of contrast challenge in the pediatric population, despite multiple pediatric institutions adopting contrast challenge algorithms" — Nate Rubocava (epidemiological) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=170)
- "The study performed retrospective review of all children undergoing contrast challenge across 5 children's hospitals over 8 years" — Nate Rubocava (clinical) [Ep 3 · 3:10](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=190)
- "By group consensus, a complication rate less than 5% would be considered safe to use a contrast challenge for clinical practice" — Nate Rubocava (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=210)
- "Major complications were defined as aspiration, pneumonia, anaphylaxis, cardiovascular complications, and renal failure; minor complications included urticaria, dyspnea, and worsening abdominal pain" — Nate Rubocava (clinical) [Ep 3 · 3:45](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=225)
- "82 children underwent a contrast challenge; 57 initially passed with 53 having clinical improvement and successful discharge; 25 failed and were taken to surgery" — Nate Rubocava (epidemiological) [Ep 3 · 4:05](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=245)
- "There was a significant age difference between groups, with those passing the challenge being a median of 7 years older, but no differences between each age group" — Nate Rubocava (epidemiological) [Ep 3 · 4:25](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=265)
- "Over 30% of patients had neurologic and pulmonary comorbidities" — Nate Rubocava (epidemiological) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=280)
- "Contrast agents used were institution-specific with relatively similar osmolality, with dilute gastrographin being the most commonly utilized agent" — Nate Rubocava (clinical) [Ep 3 · 4:50](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=290)
- "There were no major or minor complications in the study, with a 0% complication rate and confidence interval of 0 to 3.6%, significantly below the pre-set acceptable complication rate of 5%" — Nate Rubocava (epidemiological) [Ep 3 · 5:05](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=305)
- "There were no mortalities in either group" — Nate Rubocava (epidemiological) [Ep 3 · 5:25](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=325)
- "The group that failed their contrast challenge had a significantly longer hospital stay by 5 days" — Nate Rubocava (epidemiological) [Ep 3 · 5:30](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=330)
- "A total of 6 patients were readmitted within 30 days for recurrent small bowel obstruction" — Nate Rubocava (epidemiological) [Ep 3 · 5:40](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=340)
- "The contrast challenge has a sensitivity of 100%, specificity of 86%, negative predictive value of 100%, and positive predictive value of 93%" — Nate Rubocava (epidemiological) [Ep 3 · 5:50](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=350)
- "This review of 82 patients is the largest to date in children demonstrating that a contrast challenge is safe, effective, and highly predictive in children" — Nate Rubocava (epidemiological) [Ep 3 · 6:15](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=375)
- "Every institution had a similar protocol that had been mirrored to Doctor Grace Mack from University of Chicago's study from 2018" — Nate Rubocava (clinical) [Ep 3 · 5:57](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=357)
- "The Midwest Pediatric Surgery Consortium is conducting a prospective study looking at contrast challenges in pediatric adhesive small bowel obstruction" — Nate Rubocava (clinical) [Ep 3 · 6:25](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=385)
- "More pediatric surgeons have adopted the practice after the study showed it was safe and effective in predicting which children will be successfully managed non-operatively" — Nate Rubocava (opinion) [Ep 3 · 6:50](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=410)
- "This study will impact every single child that undergoes abdominal surgery because for the rest of their life they are at risk of adhesive small bowel obstruction" (opinion) [Ep 3 · 8:04](https://library.globalcastmd.com/watch/apsa-a-contrast-challenge-is-safe-in-children-with-adhesive-small-bowel-obstruction-a-multi-institutional-review-nathan-rubalcava-5366?t=484)
- "Gastrografin use for adhesive small bowel obstruction began in the adult population approximately 10 years ago." — Meera Kotagal (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=0)
- "Gastrografin is both diagnostic (visible on X-rays to track bowel transit) and therapeutic (hyperosmolar agent draws water from bowel edema into lumen)." — Meera Kotagal (clinical) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=0)
- "Gastrografin should only be used for adhesive small bowel obstructions, not in patients who have never had an operation." — Meera Kotagal (guideline) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=120)
- "Gastrografin is not appropriate for patients with concern for strangulation or peritonitis, who should be considered for immediate operative intervention." — Meera Kotagal (guideline) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=120)
- "Patients with active malignancy are excluded from the Cincinnati Children's Gastrografin protocol." — Meera Kotagal (guideline) [Ep 1 · 2:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=120)
- "Imaging confirmation of small bowel obstruction is performed with two-view abdominal X-ray or CT." — Meera Kotagal (guideline) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=180)
- "Nasogastric decompression should be performed for at least one hour, or longer if the NG continues to drain bilious fluid." — Meera Kotagal (guideline) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=180)
- "Gastrografin dosing is age-based and diluted in water to a 50% solution." — Meera Kotagal (guideline) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=180)
- "The NG tube is clamped for 8 to 10 hours after Gastrografin administration, but can be unclamped at any time if the patient is nauseated or vomiting." — Meera Kotagal (guideline) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=180)
- "A portable plain film is obtained at 10 hours; if contrast is in or past the cecum, the NG tube is removed and diet can be advanced." — Meera Kotagal (guideline) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=240)
- "If contrast has not reached the cecum at 10 hours, another X-ray is obtained at 24 hours." — Meera Kotagal (guideline) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=240)
- "If contrast has not reached the cecum by 24 hours, strong consideration is given to operative exploration." — Meera Kotagal (guideline) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=240)
- "Serial abdominal exams every four hours are required throughout the protocol to ensure the patient has not progressed to peritonitis or developed an indication for urgent operative intervention." — Meera Kotagal (guideline) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=300)
- "Cincinnati Children's has had great success using Gastrografin for management of adhesive small bowel obstructions in children." — Meera Kotagal (opinion) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/gastrografin-protocol-for-adhesive-small-bowel-obstruction-1713?t=300)

## Changelog
- Sep 25: 3 items added automatically

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