Use of oral iohexol in patients with adhesive small intestinal obstruction

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Objective: To evaluate the clinical impact of orally administered iohexol on the restoration of bowel passage and surgical outcomes in patients with adhesive small bowel obstruction. Material and Methods: This retrospective study included 120 adult patients diagnosed with adhesive small bowel obstruction between August 2021 and January 2024. Patients were categorized according to the treatment strategy used in routine clinical practice: Conservative management with oral iohexol or standard conservative management alone. Demographic data, laboratory parameters, time to restoration of bowel passage, length of hospital stay, need for surgery, readmission, recurrence, morbidity, and mortality were analyzed and compared between groups. Restoration of bowel passage was defined by both radiological and clinical criteria and was assessed using abdominal radiographs obtained at 24-hour intervals and clinical improvement. Results: Bowel passage was successfully restored with conservative treatment in 109 patients (90.8%), while 11 patients (9.2%) required surgical intervention. No statistically significant difference was observed between the groups regarding surgical requirement (p=0.755). However, patients who received oral iohexol achieved bowel passage significantly earlier than those managed without contrast [median 1 day [interquartile range (IQR) 1-2] vs. 4 days (IQR 3-5); p<0.001]. The corresponding mean times to bowel passage were 1.35 and 4.10 days, respectively. Mortality occurred only in surgically treated patients. Conclusion: Oral iohexol appears to be a safe adjunct to conservative management in patients with adhesive small bowel obstruction and is associated with earlier restoration of bowel passage. Failure of bowel passage to resolve in the early period remains an important indicator for operative management. Although no statistically significant difference in surgical requirement was observed in this cohort, larger prospective randomized controlled studies are needed to further clarify the impact of oral iohexol on clinical outcomes in adhesive small bowel obstruction.