-
Surgery Aug 2021Gastrografin challenge is increasingly used as a diagnostic tool to predict patients who may benefit from nonoperative management in adhesive small bowel obstruction....
BACKGROUND
Gastrografin challenge is increasingly used as a diagnostic tool to predict patients who may benefit from nonoperative management in adhesive small bowel obstruction. This study explores the optimal timing of Gastrografin in the management of adhesive small bowel obstruction by comparing early versus late Gastrografin challenge.
METHODS
A retrospective chart review from January 2016 to January 2018 identified patients with adhesive small bowel obstruction who underwent Gastrografin challenge. A receiver operating characteristic curve, to predict a duration of stay less than 5 days, calculated a 12-hour limit which separated early and late groups. Nonoperative and operative patients were compared separately. Our primary outcome was duration of stay. Secondary outcomes included operative requirement, time to the operating room, complication rate, and 1-year mortality. In a separate analysis, multivariable logistic regression identified independent risk factors for 1-year mortality.
RESULTS
One hundred thirty-four patients were identified (58 early, 76 late). In nonoperative patients, the early group had a shorter duration of stay (3.2 days vs 5.4 days), fewer complications, and a lower complication and 1-year mortality rate (P < .05). In operative patients, the early group had a shorter preoperative duration of stay (1.8 days vs 3.9 days) (P < .05). On multivariable regression, congestive heart failure, any postoperative complication, and operative requirement were the best predictors of 1-year mortality (R2 = 0.321; P < .05).
CONCLUSION
Gastrografin administration within 12 hours of adhesive small bowel obstruction diagnosis had favorable outcomes in terms of duration of stay, complications, and mortality in nonoperative patients. Moreover, in operative patients, preoperative duration of stay was shortened. Our findings suggest protocolizing early Gastrografin challenge may be an important principle in adhesive small bowel obstruction management.
Topics: Aged; Aged, 80 and over; Contrast Media; Diatrizoate Meglumine; Drug Administration Schedule; Female; Humans; Intestinal Obstruction; Intestine, Small; Length of Stay; Male; Middle Aged; Patient Selection; Predictive Value of Tests; ROC Curve; Retrospective Studies; Tissue Adhesions; Tomography, X-Ray Computed
PubMed: 33836900
DOI: 10.1016/j.surg.2021.03.008 -
ANZ Journal of Surgery Nov 2022
Topics: Humans; Diatrizoate Meglumine; Intestinal Obstruction; Intestine, Small
PubMed: 36398343
DOI: 10.1111/ans.17958 -
Frontiers in Surgery 2023Enterocutaneous fistula is one of the most challenging problems facing surgeons. In severe cases, a large amount of fluid loss can lead to problems such as water and...
BACKGROUND
Enterocutaneous fistula is one of the most challenging problems facing surgeons. In severe cases, a large amount of fluid loss can lead to problems such as water and electrolyte acid-base imbalance, malnutrition, infection, and organ dysfunction. Here we reported a case of platelet-rich plasma combined with lyophilizing thrombin powder for the treatment of complicated enterocutaneous fistula.
CASE PRESENTATION
A 48-year-old male, more than 2 years after the operation of abdominal trauma, the leakage of the fistula in the right upper abdominal wall was accompanied by fever for 3 days. The Contrast Fistulography and upper abdomen CT accurately depicted the entry of the meglumine diatrizoate into the small intestine through the small fistula. The patient had a large abdominal wall defect and severe intestinal adhesions. Reoperation may lead to more serious ECF. Therefore, we decided to seal the fistulas with PRP combined with lyophilizing thrombin powder.
CONCLUSIONS
The findings in this case report suggest that the combination of PRP and lyophilized thrombin powder holds promise as a viable approach for managing ECF in patients with chronic abdominal wall fistulas, as it appears to facilitate fistula closure, reduce healing time, and improve patient outcomes.
PubMed: 37928064
DOI: 10.3389/fsurg.2023.1252045 -
BMJ Supportive & Palliative Care Jan 2024Malignant bowel obstruction (MBO) is a common, challenging condition in advanced cancer. Oral water-soluble contrast medium (Gastrografin) has been used in the...
OBJECTIVES
Malignant bowel obstruction (MBO) is a common, challenging condition in advanced cancer. Oral water-soluble contrast medium (Gastrografin) has been used in the management of MBO without quality studies of its effectiveness and safety. The purpose of this study was to evaluate the feasibility, effectiveness and adverse effects of Gastrografin in patients with MBO and to assess feasibility of the study protocol.
METHODS
A prospective, interventional, single-arm, open label study of Gastrografin across two centres. Patients with unresolved inoperable MBO after 24 hours of conservative medical management were given a single dose of 100 mL of oral Gastrografin.
RESULTS
Over 33 months, 69 individual patients were screened. Of the 20 recruited, 17 completed study assessments (85%). MBO resolved in 10 of 17 patients (59%). Gastrografin passed through to the rectum in 14 patients (78%). The most common adverse effects were diarrhoea, vomiting, nausea and abdominal pain.
CONCLUSIONS
Patient recruitment took longer than anticipated, but the study protocol is feasible. Gastrografin was found to be a relatively effective option for the treatment of MBO. An adeqautely powered randomised controlled trial is needed to formally assess the efficacy and safety of Gastrografin© in MBO.
Topics: Humans; Contrast Media; Diatrizoate Meglumine; Intestinal Obstruction; Pilot Projects; Prospective Studies; Water
PubMed: 35045980
DOI: 10.1136/bmjspcare-2021-003444 -
The American Journal of Forensic... Sep 2021We report cause of death after cardiac surgery using isolated cardiopulmonary organ computed tomography angiography (CTA) and a conventional autopsy. A 56-year-old man...
We report cause of death after cardiac surgery using isolated cardiopulmonary organ computed tomography angiography (CTA) and a conventional autopsy. A 56-year-old man underwent aortic valve replacement and coronary artery bypass graft surgery under extracorporeal circulation. Massive bleeding occurred suddenly, and the patient died 25 days later. An autopsy revealed fibrinous exudate in the mediastinum and tight attachment of the pericardium to the heart; there were also clots and inflammatory exudate in the chest cavity. Separating the organs in the chest cavity was difficult, especially in the surgical area. We extracted the heart and lungs together and performed cardiovascular CTA and image reconstruction. Results showed spillage of the contrast agent from the anterior wall of the ascending aorta, approximately 4.5 cm from the replaced aortic valve. A histological examination confirmed that the site of contrast agent spillage was the sutured area of the ascending aorta, which was infected, necrotic, and had ruptured. Using the CTA approach for isolated cardiopulmonary organ imaging can accurately display the location of an aortic rupture, which further guides organ inspection and tissue sampling, and avoids irreversible damage to key regions. In conclusion, the approach we describe can provide evidence for determining cause of death.
Topics: Aorta; Aortic Rupture; Aortic Valve; Autopsy; Computed Tomography Angiography; Contrast Media; Coronary Artery Bypass; Diatrizoate Meglumine; Extracorporeal Circulation; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 33346976
DOI: 10.1097/PAF.0000000000000638 -
Journal of Medical Imaging and... Oct 2020Dual-energy CT is able to distinguish between materials based on differences in X-ray absorption at different X-ray beam energies. The strong k-edge photoelectric effect...
BACKGROUND
Dual-energy CT is able to distinguish between materials based on differences in X-ray absorption at different X-ray beam energies. The strong k-edge photoelectric effect of materials with a high atomic number makes this modality ideal for identifying iodine-containing compounds. We aim to evaluate dual-energy CT for the detection of Gastrografin (GG) (diatrizoate, Bayer PLC, Reading, UK) enteric contrast medium and validate the conditions for the measurement in ex vivo samples.
METHODS
Dual-energy CT acquisitions were performed to detect Gastrografin in serial dilutions of water, saline and body fluids. We also evaluated the stability of Gastrografin solutions over time at room temperature. Stool specimens were examined to validate the proposed study protocol for clinical applications.
RESULTS
Concentrations as low as 0.2% of Gastrografin were reproducibly detected in vitro and ex vivo samples by DECT, with linear readings ranging from 0.2% to 25% Gastrografin. Gastrografin was shown to be stable in ex vivo biological samples, and there was no difference in detection over time. Gastrografin was detected in stool specimens when administered orally. The detection curves followed the expected saturation effect at high concentrations of iodine.
CONCLUSIONS
Dual-energy CT offers a convenient, quick, reliable and reproducible method for detecting and quantifying the presence of Gastrografin in ex vivo clinical specimens. Biological solutions containing Gastrografin are stable over time. A minimum dilution level of 25% is suggested to avoid beam saturation and inaccurate results.
Topics: Contrast Media; Diatrizoate Meglumine; Drug Stability; Feces; Humans; In Vitro Techniques; Phantoms, Imaging; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 32543123
DOI: 10.1111/1754-9485.13071 -
BMC Gastroenterology Aug 2019Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to...
BACKGROUND
Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to complications, and there is a risk of malignant transformation. Thoracotomy or thoracoscopy is the most commonly used approach for complete excision of the cysts. To our knowledge, this is the first report to excise intramural esophageal bronchogenic cyst completely by endoscopic submucosal tunnel dissection (ESTD).
CASE PRESENTATION
A 40-year-old male was referred to our hospital due to the detection of a submucosal tumor at the distal esophagus. The tumor was found during gastroendoscopy in a general health check-up. The patient had no symptoms. A benign esophageal tumor was confirmed by endoscopic ultrasonography (EUS) and computed tomography (CT). On the basis of these results, ESTD was performed. During the procedure, a cystic mass was observed between the mucosa and the muscular layers of the esophagus, and a hybrid knife was used for dissection. Histopathological examination showed the cyst wall was lined by pseudostratified ciliated columnar epithelium, consistent with a bronchogenic cyst. The esophagography using meglumine diatrizoate showed no leakage on the seventh day after ESTD. The patient remained asymptomatic and had a regular diet during the follow-up period.
DISCUSSION AND CONCLUSIONS
We successfully utilized ESTD for complete removal of esophageal bronchogenic cysts originating from the muscularis propria. The approach appeared safe, providing a minimally invasive treatment option for patients.
Topics: Adult; Bronchogenic Cyst; Endoscopic Mucosal Resection; Esophageal Cyst; Esophagoscopy; Humans; Male; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31462259
DOI: 10.1186/s12876-019-1072-3 -
Khirurgiia 2021To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted...
OBJECTIVE
To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast.
MATERIAL AND METHODS
There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches.
RESULTS
Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach.
CONCLUSION
Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.
Topics: Adhesives; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Intestine, Small; Tissue Adhesions
PubMed: 34029035
DOI: 10.17116/hirurgia202106145 -
Medical Science Monitor : International... Mar 2021BACKGROUND This retrospective cohort study from a single center aimed to compare patient outcomes following the use of the water-soluble contrast medium Gastrografin in...
Use of the Water-Soluble Contrast Medium Gastrografin in Treatment of Adhesive Small Bowel Obstruction in Patients with and Without Chronic Radiation Enteropathy: A Single-Center Retrospective Study.
BACKGROUND This retrospective cohort study from a single center aimed to compare patient outcomes following the use of the water-soluble contrast medium Gastrografin in the treatment of adhesive small bowel obstruction (ASBO) in patients with and without a history of chronic radiation enteropathy (CRE). MATERIAL AND METHODS Fifty-nine patients with CRE-induced small bowel obstruction (SBO) and 53 patients with ASBO at Jinling Hospital between April 2014 and February 2018 were enrolled. The patients were given 100 ml Gastrografin through a naso-jejunal tube, and erect abdominal X-rays were taken. Risk factors were found to be correlated with successful non-operative management (SNM) through statistical analyses. RESULTS The success rate of conservative treatment was higher in the Gastrografin group than in the control group (P<0.05). The Gastrografin challenge test is predictive of need for surgery in CRE-induced SBO and ASBO (AUC=0.860 and 0.749, respectively). The predictors associated with SNM in the CRE-induced SBO group were the total dose of radiotherapy, the Gastrografin challenge test, and previous operations for SBO. In the ASBO group, the predictors were the Gastrografin challenge test and previous operations for SBO. The operation rate of SBO patients with Gastrografin treatment was significantly lower than that in the control group (P<0.05). CONCLUSIONS The findings from this study showed that the use of Gastrografin effectively resolved ASBO in patients with and without a history of CRE, but a long-term requirement for surgery could not be avoided. The Gastrografin challenge may be a useful test to predict surgical outcomes.
Topics: Adult; Aged; Cohort Studies; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Radiation Injuries; Retrospective Studies; Solubility; Tissue Adhesions; Treatment Outcome; Water
PubMed: 33771966
DOI: 10.12659/MSM.930046 -
Japanese Journal of Radiology Aug 2023
Topics: Humans; Diatrizoate Meglumine; Off-Label Use; Insurance, Health; Radiologists
PubMed: 36913009
DOI: 10.1007/s11604-023-01404-3