Gastrografin for Adhesive Small Bowel Obstruction (SBO)

Updated 8/2019 v3.0 Sources:•Grant HW et al. Adhesions after abdominal surgery in children. JPS2008;43(1):152-156. •Branco BC et al. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. BJS2010;97(4):470-478. •Lee CY et al. Evaluation of a water-soluble contrast agent for conservative management of adhesive small bowel obstruction in pediatric patients. JPS2015;50(4):581-585. •Linden et al. Evaluation of a water-soluble contrast protocol for non-operative management of pediatric adhesive small bowel obstruction. JPS2019;54(1):184-188.•ZeilinskiMD et al. Multi-institutional, prospective, observational study comparing the Gastrograffinchallenge versus standard treatment in adhesive small bowel obstruction. J Traumand ACS 2017;83(1):47-54. **GastrografinDose by age:•Age ≥8 years: 100 cc gastrografin+ 100 cc water (total 200 cc)•Age <8 years: 50 cc gastrografin+ 50 cc water (total 100 cc)Orderplaced in EPIC by surgery team, gastrografinobtained from fluorotech, and diluted by surgical team and administered GastrografinProtocol for AdhesiveSmall Bowel Obstruction (SBO)Patient with suspected adhesiveSBO 2V AXR or CT confirming SBO NGT decompression with appropriate size tube* for at least1 hourTube should be placed by surgical team if not yet in place at time of consultationSigns of strangulation, peritonitis, known active malignancy, non-adhesive SBOYesTo OR as indicated No Confirm NGT tip is in stomach Administer gastrografin(diatrizoate meglumine)** and clamp NGT for 8-10 hours Plain non-portable AXR at 10 hours Contrast in or past cecum?NoPlain AXR at 24 hoursContrast in or past cecum?YesD/C NGT and advance diet at appropriate rate YesD/C NGT and advance diet at appropriate rate No *Appropriate NGT tube size by age:Exclusion Criteria:•Clinical or radiographic suspicion of strangulation•Non-adhesive SBO•No prior abdominal surgery•Peritonitis•Active malignancy•Surgical/medical team decision Wt(kg)NGT Size (Fr)SuggestedNewborn/Infant3 -95 -88Toddler10 -118 -1010Small Child12 -141012Child15 -1810 -1214Child19 -2312 -1416Large Child/Adult>2412 -1818 Unclamp NGT , place back to suctionPatient nauseated or vomitingSerial exams q4 hours should be performed by surgical team