Tarek Noel Hanna MD, Abstract Co-Author: Nothing to Disclose

Seyed Amirhossein Razavi MD, Abstract Co-Author: Nothing to Disclose

Drew Anthony Streicher MD, MBA, Presenter: Nothing to Disclose

Jamlik-Omari Johnson MD, Abstract Co-Author: Nothing to Disclose

Kimberly E. Applegate MD, MS, Abstract Co-Author: Co-editor, Springer Science+Business Media Deutschland GmbH Advisory Board, WellPoint, Inc

Current oral prep for adult abdominal-pelvic CT (AP CT) has shortened to one hour to facilitate faster Emergency Department (ED) patient care. How often does oral contrast optimally opacify the gastrointestinal tract? Does this contrast reach the site of pathology or assist in diagnosis?

All adults undergoing AP CT exams in the ED at two university-affiliated urban hospitals were identified via the healthcare database over a 3-month period in 2012. Two raters reviewed CTs for the proximal and distal location of enteric contrast. Presence, site, and type of bowel pathology as well as prior gastrointestinal surgery were documented. When applicable, the site of bowel pathology was evaluated for the presence or absence of enteric contrast.

Of 1349 patients, 530 (39%; 61% female, mean age 50+/- 19 years) were administered oral contrast. In 321/530 (61%), oral contrast reached the terminal ileum (TI). Bowel pathology was present in 31% of these cases (165/530). When small or large bowel pathology was present, 47% (77/165) of cases had oral contrast present at the bowel pathology site. When the bowel was categorized into 4 anatomic segments, there was a significant difference (p<0.001) in oral contrast reaching the site of bowel pathology based on location: stomach and duodenum (84%), jejunum to TI (35%), proximal colon (57%), and distal colon (28%). In 8% of cases (41/530), the original interpretation was equivocal for bowel pathology. 59% (24/41) of these equivocal cases had oral contrast present at the site of pathology. Of all 530 oral contrast cases, in only 84 cases (16%) did contrast extend from the stomach to the distal colon.

Only 61% of adults in the ED that undergo CT achieve oral contrast passage to the TI. 16% had complete stomach to distal colon contrast distribution. Oral contrast was present at the possible pathology site in equivocal reports (59%) in a similar frequency to positive cases (47%). These results raise questions about the use of oral contrast to facilitate identification and characterization of bowel pathology, unless prep time is lengthened.

ED length of stay time pressures continue to intensify, leading to shorter prep times for oral contrast administration. As a result, optimal CT bowel prep is not achieved in many patients.  

Hanna, T, Razavi, S, Streicher, D, Johnson, J, Applegate, K, Evaluation of the Distribution of Enteral Contrast in ED Patients Undergoing Abdominal-Pelvic CT: Does It Get Where It Is Supposed to Go and What Is the Added Value?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003156.html