Joseph Monteiro MD, Presenter: Nothing to Disclose

Stephan W. Anderson MD, Abstract Co-Author: Nothing to Disclose

Holly Milch, Abstract Co-Author: Nothing to Disclose

James Travis Rhea MD, Abstract Co-Author: Stockholder, General Electric Company

Jorge A. Soto MD, Abstract Co-Author: Researcher, General Electric Company

To assess outcomes after implementation of non-oral contrast protocol for IV contrast-enhanced CT (CECT) performed for patients with body mass index (BMI) >25 presenting to the emergency department (ED) with acute abdominal pain.

Our institution recently instituted a non-oral contrast protocol for CECT in patients with BMI>25 presenting to the ED with acute abdominal pain. All adult patients receiving this protocol from January 2009 to November 2009 were included in this IRB approved, HIPAA compliant study. 204 patients with mean age of 49 years and mean BMI of 33 were included. The findings of the CT scans were recorded, in addition to the final clinical diagnosis and the need for repeat CT with oral contrast.

105 of the 204 (52%) CT scans showed no acute abnormality. Of the remaining 99 patients, 11 patients were diagnosed with appendicitis at CT; 10 were confirmed at surgery and 1 was found to be a mucocele. An additional exam was interpreted as indeterminate for appendicitis; the patient was successfully managed conservatively. 14 diagnoses of acute colonic diverticulitis were made at CT, all of which were clinically treated for diverticulitis. A single patient status post recent hemicolectomy was found to have intraperitoneal air at CT noting that the evaluation of an enteric leak was limited without enteric contrast; surgical exploration 9 days later revealed anastomotic leak. 95 patients (47%) were admitted with mean length of stay of 4.1 days. 9 patients returned to the ED within 7 days of the initial visit with persistent or recurrent symptoms, but none had a new diagnosis made. None of the patients imaged with this protocol received repeat CT scan based on perceived lack of diagnostic quality by the radiologist.

A non-oral contrast CT protocol affords a time efficient evaluation which may be appropriate for obese and overweight patients. Limitations of such a protocol may include decrease in confidence in some cases such as highlighted by the indeterminate appendicitis case. This protocol may not be appropriate in patients with recent surgery for which enteric leak is of clinical concern.

This study presents the potential for eliminating the use of oral contrast in the CT evaluation of obese patients with abdominal pain and highlights potential limitations in certain cases.

Monteiro, J, Anderson, S, Milch, H, Rhea, J, Soto, J, Non-Oral Contrast CT Protocol for Acute Abdominal Pain in Overweight and Obese Patients: Initial Single Center Experience.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9012668.html