1071 Evaluation of Adhesive Small Bowel Obstruction Management: Insights from a Retrospective Analysis

Adhesive small bowel obstruction (SBO) is typically managed conservatively with early administration of gastrografin within 12 hours of admission. However, at our institution, there is currently no established protocol. Therefore, our study aims to evaluate the variability in SBO management and summarise the existing practices. This was a retrospective audit between November 2022 and August 2023. Our primary objective was to assess the timing of gastrografin administration and the timing of subsequent imaging. Our analysis included 49 patients with a mean age of 65.6 years (±16.8 years). The average time elapsed between CT imaging and the first dose of gastrografin was 1 day, 5 hours, and 51 minutes (±8 hours, 33 minutes). The average time between the first dose of gastrografin and follow-up imaging was 7 hours and 37 minutes (range: 2 hours, 58 minutes – 10 hours, 14 minutes). The average interval between discharge date and the first dose of gastrografin was 4.0 days (±3.2 days). Only 22% of patients were referred to a dietitian during their hospital stay, with an average referral duration of 3.5 days (±4.7 days). The average length of hospital stay was 6.7 days. Conclusions Our findings highlight an underutilization of gastrografin in conservative SBO management. While follow-up imaging approximated the ideal 6-hour window in practice, there were deviations from this target on several occasions. Additionally, the use of dietitian referrals did not align with management targets. We recommend the establishment of a formalized protocol for SBO management, incorporating guidelines for a 6-hour follow-up abdominal X-ray and timely dietitian reviews.