Gastrografin Protocol for Adhesive Small Bowel Obstruction (SBO)

Gastrografin use for adhesive small bowel obstruction began in the adult population approximately 10 years ago.

Gastrografin is both diagnostic (visible on X-rays to track bowel transit) and therapeutic (hyperosmolar agent draws water from bowel edema into lumen).

Gastrografin should only be used for adhesive small bowel obstructions, not in patients who have never had an operation.

Gastrografin is not appropriate for patients with concern for strangulation or peritonitis, who should be considered for immediate operative intervention.

Patients with active malignancy are excluded from the Cincinnati Children's Gastrografin protocol.

Imaging confirmation of small bowel obstruction is performed with two-view abdominal X-ray or CT.

Nasogastric decompression should be performed for at least one hour, or longer if the NG continues to drain bilious fluid.

Gastrografin dosing is age-based and diluted in water to a 50% solution.

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.

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.

If contrast has not reached the cecum at 10 hours, another X-ray is obtained at 24 hours.

If contrast has not reached the cecum by 24 hours, strong consideration is given to operative exploration.

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.

Cincinnati Children's has had great success using Gastrografin for management of adhesive small bowel obstructions in children.