Oral gastrografin protocol resolves worm-induced small bowel obstruction in children: a prospective cohort study.

BACKGROUND: Worm-induced small bowel obstruction (SBO) is a common pediatric surgical problem in endemic regions, but the role of oral Gastrografin in this setting remains unclear. METHODS: We conducted a prospective cohort study (December 2022–December 2024) at a single center in Pakistan. Children aged 5–18 years with radiological and clinical evidence of uncomplicated Ascaris-related SBO were included. Exclusions were complicated obstruction, rectal bleeding, hypersensitivity to Gastrografin, or refusal to participate. Participants received either standard conservative management (nil per os, nasogastric decompression, intravenous fluids, antibiotics, enemas, antispasmodics) or the same regimen plus Gastrografin 2 mL/kg via nasogastric tube (diluted 1:1 with saline). The primary outcome was hospital length of stay (LOS). Secondary outcomes were time to oral intake, pain resolution, passage of flatus and stool, laparotomy, and in-hospital complications. RESULTS: One hundred and twenty children were enrolled (60 per group). Baseline characteristics were similar. Gastrografin was associated with a shorter LOS (35 ± 15 vs. 60 ± 15 h; mean difference − 25.0, 95% CI − 30.4 to − 19.6; p < 0.001). Recovery milestones occurred earlier, including oral intake (30.2 ± 6.0 vs. 60.5 ± 15.6 h), pain resolution (14.2 ± 4.5 vs. 45.8 ± 12.4 h), passage of flatus (20.9 ± 9.0 vs. 48.8 ± 12.1 h), and stool (15.9 ± 8.0 vs. 48.8 ± 12.1 h) (all p ≤ 0.002). Laparotomy was infrequent (3/60 vs. 5/60; p > 0.05). No Gastrografin-related adverse events occurred under hydration protocols. CONCLUSIONS: In this cohort, oral Gastrografin as an adjunct to conservative care was associated with faster recovery and shorter hospitalisation without new safety concerns. Multicenter randomized studies are needed to confirm effectiveness and guide standardised protocols.