Gastric Emptying Time of Oral Contrast Material in Children and Adolescents Undergoing Abdominal Computed Tomography

INTRODUCTIONInternal herniation with subsequent bowel obstruction is uncommon, and making a correct diagnosis prior to surgery is often difficult.PRESENTATION OF CASEIn this case report we present a man, who suffered from sudden extreme right-sided abdominal pain. The diagnostic workup was inconclusive. Emergency surgery was indicated with a suspicion of acute appendicitis. We found a strangulated ileus caused by an internal herniation of the small intestine through a hole in the greater omentum. The patient had no history of surgery or other physical disorders explaining this finding. The obstruction was resolved and the postoperative clinical course was uncomplicated.DISCUSSIONA thorough diagnostic workup including CT scan would most probably have given the correct diagnosis. However, the clinical course and initiation of the correct treatment would have been delayed significantly.CONCLUSIONWe suggest that the diagnostic workup of patients with unclear lower abdominal pain should be limited and that acute clinical symptoms require rapid laparoscopic evaluation and surgical treatment.

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“…Also, the risk of aspiration after administration of oral contrast media should be taken into account. 11 …”

Section: Discussionmentioning

confidence: 99%

Internal transomental herniation with a trapped small bowel mimicking acute appendicitis

Rudroff

Balogh

Hilswicht

2013

International Journal of Surgery Case Reports

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“…In 1 particular study, 50% of patients were reported to have residual oral contrast in the stomach for greater than 1 hour after administration; 25% of patients were found to have residual oral contrast in the stomach for greater than 2 hours, and a single patient was found to have oral contrast in the stomach nearly 3 hours after administration. 5 In light of these findings, the authors advocated waiting at least 3 hours between the administration of oral contrast for CT and the induction of general anesthesia, introducing the potential for delays in management. In a recent large study analyzing the effects of oral contrast, it was found that in nearly 20% of patients with appendicitis, the administration of oral contrast material induced emesis, and nasogastric tubes were place in more than 5% of patients for the administration of oral contrast.…”

Section: Oral Contrastmentioning

confidence: 98%

Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations

Anderson

Soto

2012

Radiologic Clinics of North America

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“…The administration of enteric contrast medium in children who require sedation/anesthesia for abdominal computed tomography (CT) has been a long-standing practice at most large pediatric centers [ 4 ]. While a 2010 study of 101 children found that 75% of patients had enteric contrast medium in the stomach 48 ± 5.2 min after the completion of enteric contrast medium ingestion, 50% after 74 ± 7.9 min, and 25% after 135 ± 32.5 min [ 5 ], the current goal is to obtain a CT scan within one hour of receiving enteric contrast medium [ 6 ] because, in 83% of cases, small bowel transit time is less than two hours. While the average small bowel transit time is one hour and 24 min, transit time can be as fast as 15 min [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing Residual Gastric Fluid Volume after Administering Diluted Oral Contrast until One Hour Prior to Anesthesia in Children: An Observational Cohort Study

Narayanasamy,

Fleck,

Kandil

et al. 2024

JCM

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Background: Gastric fluid volume has been used as a surrogate marker for pulmonary aspiration risk in studies evaluating fasting protocol safety. This study measured residual gastric fluid volume in children using a protocol in which diluted oral contrast medium was administered up until one hour before anesthesia. Methods: This was a single-center prospective observational cohort trial of 70 children for elective abdominal/pelvic computed tomography (CT). Imaging was performed after diluted enteral contrast medium administration, beginning two hours before and ending at least one hour before induction. For each patient, gastric fluid volume was calculated using an image region of interest. The primary outcome measure was gastric fluid volume measured using the computed tomography image. Results: The median time from the end of contrast administration to imaging was 1.5 h (range: 1.1 to 2.2 h). Residual gastric volume, measured using CT was <0.4 mL/Kg in 33%; ≥0.4 mL/Kg in 67%; and ≥1.5 mL/Kg in 44% of patients. Residual gastric volumes measured using CT and aspiration were moderately correlated (Spearman’s correlation coefficient = 0.41, p = 0.0003). However, the median residual gastric volume measured using CT (1.17, IQR: 0.22 to 2.38 mL/Kg) was higher than that of aspiration (0.51, IQR: 0 to 1.58 mL/Kg, p = 0.0008 on differences in paired measures). Three cases of vomiting were reported. No evidence of pulmonary aspiration was identified. Conclusions: Children who receive large quantities of clear fluid up to one hour before anesthesia can have a significant gastric residual volume.

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Gastric Emptying Time of Oral Contrast Material in Children and Adolescents Undergoing Abdominal Computed Tomography

Abstract: : Given the variability of GET of OCM and if clinically feasible, we advocate waiting at least 3 hours between completion of OCM ingestion and general anesthesia induction.

Cited by 11 publications

References 22 publications

Internal transomental herniation with a trapped small bowel mimicking acute appendicitis

Internal transomental herniation with a trapped small bowel mimicking acute appendicitis

Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations

Assessing Residual Gastric Fluid Volume after Administering Diluted Oral Contrast until One Hour Prior to Anesthesia in Children: An Observational Cohort Study

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