Indications and contraindications of WSOC challenge in small bowel obstruction. Use or abuse?

Introduction: Water Soluble Oral Contrast (WSOC) Challenge for adhesive small bowel obstruction (SBO) is a common strategy. Its utilization although has absolute and relative contraindications according to literature. However, its "off-label" use may bring benefits to a subgroup of patients.

Objective: To analyze our experience with WSOC Challenge.

Methods: Retrospective analysis of a prospective database of consecutive patients admitted for SBO in our institution from January 1^st 2022 to July 31^st 2023, in witch WSOC was given. Series was divided in two cohorts according to the presence of any WSOC challenge contraindication defined as use and abuse groups.

Results: 396 SBO patients have been admitted in our institution during study period. 133 patients (34%) underwent WSOC challenge. 54.1% male sex, mean age 67±14 years old. 92% present with at least one previous abdominal surgery. Diagnosis differ among cohorts including adhesions, incarcerated hernias, bezoars, radiation enteritis, carcinomatosis among others. Success rate for WSOC challenge was 74% in use vs. 67% abuse (p=0.44). There were no significant differences among groups in time to WSOC administration, number of X rays, time to discharge if success or time to operation if failure, but complications were higher in abuse group (16.5%vs.33.3%;p=0.043). No differences in readmission nor mortality were observed.

Conclusion: WSOC challenge is a safe strategy in SBO patients regardless indications other than adhesions or the presence of relative contraindications although always should be given in a protocolized manner.

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