A Prospective Randomised Pilot Study on the Timing of Contrast Media Administration in Adhesive and Virgin Abdomen Small Bowel Obstruction

Background and Objectives: Small bowel obstruction (SBO) is a common surgical emergency, accounting for 15–20% of acute general surgical admissions. Despite the Bologna Guideline’s introduction to the surgical community almost a decade ago, adherence to it remains variable. The therapeutic role of contrast media and the optimal timing of its administration remain a matter of debate. This study aimed to compare SBO resolution rates according to the timing of water-soluble contrast media (WSCM) administration. Materials and Methods: A prospective, randomised pilot trial was conducted at two regional hospitals in Estonia. Patients hospitalised with adhesive or virgin abdomen SBO were randomised to receive WSCM at either 4 h or 24 h after admission. Results: A total of 128 patients were enrolled, with 63 assigned to the 4 h group and 65 to the 24 h group. SBO resolved with conservative management in 74.6% of patients in the 4 h group and 73.8% in the 24 h group. Rates of surgical intervention and bowel resection due to necrosis were comparable between groups. Univariable and multivariable analyses showed no significant association between early administration and improved resolution. A prior history of SBO was associated with a higher likelihood of successful non-operative management. Conclusions: conservative management of SBO is safe and effective, and early WSCM administration did not provide a clear additional benefit in this cohort with respect to resolution or surgical outcomes. A prior history of SBO was associated with a higher likelihood of successful conservative management in this cohort. Larger multicentre studies are warranted to further define the optimal timing of contrast administration and to compare isotonic and hyperosmolar agents with respect to clinical outcomes.