Management of adhesive small-bowel obstruction.

1. Early identification of strangulated bowel allows for faster treatment and improved outcomes. 2. Accurate diagnosis of strangulation cannot be made using physical exam or laboratory studies. 3. Most sensitive and specific modality for diagnosing strangulation is a non-contrast CT scan followed by an arterial and venous phase looking for enhancement of bowel wall. 4. Oral Gastrografin has been shown to be both diagnostic and therapeutic in the management of adhesive small bowel obstruction. a. Decreases time to resolution. b. Decreases hospital length of stay. c. Contrast in the colon after 24 hours is 99% predictive of resolution of obstruction. 5. 100% of patients who will resolve their obstruction non-operatively will show signs of resolution within 48 hours 6. Non-operative management can be safely carried out for up to 72 hours.