Use of water-soluble oral contrast media in patients with high adhesive intestinal obstruction. Utilization protocol in a university center

Abstract

Objectives: To describe the implementation of an oral water-soluble contrast protocol for the initial management of adhesive small bowel obstruction between 2017 and 2024, and to evaluate its clinical and economic outcomes.

Materials and Methods: A retrospective descriptive observational study was conducted including adult hospitalized patients diagnosed with adhesive small bowel obstruction who were initially managed with oral water-soluble contrast between January 2017 and December 2024. Cases with an indication for urgent surgery and obstructions of neoplastic origin were excluded. Clinical variables, surgical rate, length of hospital stay, 90-day mortality, readmissions, and hospital costs were analyzed, comparing outcomes across biennial periods. Statistical analysis was performed using Python® v3.11 and RStudio®, with a p value < 0.05 considered statistically significant.

Results: A total of 110 patients were included. The contrast passage rate increased from 79.3% in 2017–2018 to 86.7% in 2023–2024. In parallel, the surgical rate decreased from 20.7% to 13.3%. Median length of stay ranged from 3.0 to 6.0 days, with a significant reduction observed in the most recent years (p = 0.032). Ninety-day mortality was null throughout most of the study period, except in 2023–2024, when it reached 3.3%. Readmission rates ranged from 6.9% to 26.1%. Hospital costs showed a significant decrease, from USD 2,403 in 2019–2020 to USD 1,361 in 2023–2024.

Conclusion: The protocol proved to be a safe, effective, and feasible strategy, associated with a lower need for surgery, shorter hospitalization, and reduced hospital costs.