Use of Gastroduodenal Manometry to Differentiate Mechanical and Functional Intestinal Obstruction: An Analysis of Clinical Outcome

Objectives: Our aim was to assess the outcome patients whose astrointestinal motility recording suggested intestinal mechanical obstruction. Methods: Medical records were reviewed for operative reports and alternative diagnoses during at least 1‐yr follow‐up. Results: During 1988‐1992, 27 of 890 consecutive manometric recordings suggested mechanical obstruction: 20 with non propagated, prolonged contractions, seven with a pattern of nonpropagated clustered contractions that lasted >30 min. Obstruction was confirmed laparotomy in 17 (including two with progressive systemic sclerosis) and by radiology in one. In confirmed obstruction, 12 of 18 contrast radiographs performed prior to manometry were either normal or nondiagnostic. One laparotomy was negative for obstruction; nine patients who did not undergo laparolomy were classified as unobstructed. Manometric recordings showed prolonged contractions in two, clustered contractions three, and a mixed pattern in four. Positive predictive values of these patterns for obstruction were: prolonged contractions, 82%; clustered contractions, 57%; and mixed pattern, 56%. Conclusions: Thus, nonpropagated, prolonged contractions in small bowel should prompt a search for obstruction, even when this equivocal on barium small bowel radiography.