Enteric Distribution of Oral Contrast in Emergency Department Patients Undergoing Abdominal-Pelvic Computed Tomography

Abstract Purpose The study sought to assess the gastrointestinal (GI) distribution of oral contrast (OC) among emergency department (ED) patients and determine if contrast reaches the terminal ileum or site of pathology to assist in diagnosis. Methods Retrospectively, adults undergoing abdominal-pel...

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Bibliographic Details
Published in:Canadian Association of Radiologists journal 2016-08, Vol.67 (3), p.204-211
Main Authors: Hanna, Tarek N., MD, Streicher, Drew A., MD, MBA, Razavi, Seyed Amirhossein, MD, Khosa, Faisal, MD, MBA, Johnson, Jamlik-Omari, MD, Applegate, Kimberly E., MD, MS
Format: Article
Language:English
Subjects:
Abdomen - diagnostic imaging
Abdominal pain
Abdominal-pelvic computed tomography
Administration, Oral
Adolescent
Adult
Aged
Aged, 80 and over
Colon - diagnostic imaging
Computed tomography protocols
Contrast Media - administration & dosage
Contrast Media - analysis
Dyes
Emergency department
Emergency medical care
Emergency Service, Hospital
Female
Gastrointestinal Tract - diagnostic imaging
Gastrointestinal Tract - surgery
Humans
Ileum - diagnostic imaging
Intestinal Diseases - diagnostic imaging
Jejunum - diagnostic imaging
Male
Medical imaging
Middle Aged
Oral contrast
Patients
Pelvis - diagnostic imaging
Radiology
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Young Adult
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Summary:Abstract Purpose The study sought to assess the gastrointestinal (GI) distribution of oral contrast (OC) among emergency department (ED) patients and determine if contrast reaches the terminal ileum or site of pathology to assist in diagnosis. Methods Retrospectively, adults undergoing abdominal-pelvic computed tomography (APCT) in the ED at 2 hospitals were identified over a 3-month period. APCTs were reviewed for location of OC. Presence, site, type of bowel pathology, and prior gastrointestinal surgery were documented. When applicable, the site of bowel pathology was evaluated for the presence or absence of OC. Results There were 1349 exams with mean age 50.5 years (range 18–97 years), 41% male, with 530 (39%) receiving OC. In 271 of 530 (51%), OC reached the terminal ileum (TI). Bowel pathology was present in 31% of cases (165 of 530). When bowel pathology was present, 47% (77 of 165) had OC present at the pathology site. The GI tract was divided into 4 anatomic segments: OC most frequently reached pathology in stomach and duodenum (84%), but was present less frequently at sites of pathology from jejunum to TI (35%), proximal colon (57%), and distal colon (28%). In only 84 of 530 OC cases (16%) did contrast extend from the stomach to distal colon. OC administration contributed to longer mean APCT order to final report of 0.5 hours and longer mean ED length of stay of 0.8 hours compared with all patients who received APCT. Conclusions Optimal OC distribution is not achieved in more than half of ED patients, raising questions about the continued use of OC in the ED.
ISSN:0846-5371
1488-2361
DOI:10.1016/j.carj.2015.09.008