Small Bowel Obstruction Following Computed Tomography and Magnetic Resonance Enterography Using Psyllium Seed Husk As an Oral Contrast Agent

Chen, Yingming Amy; Cervini, Patrick; Kirpalani, Anish; Vlachou, Paraskevi A.; Grover, Samir C.; Colak, Errol

doi:10.1155/2014/501043

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…The use of this high dose of psyllium may carry the risk of bowel obstruction in patients with pre-existing small bowel strictures. 30 This is demonstrated by two cases of obstruction in a combined cohort of 68 patients with Crohn's disease undergoing CTE with psyllium. 24,25,30 More studies are required before the risk of obstruction in MRE can be established.…”

Section: Discussionmentioning

confidence: 97%

“…30 This is demonstrated by two cases of obstruction in a combined cohort of 68 patients with Crohn's disease undergoing CTE with psyllium. 24,25,30 More studies are required before the risk of obstruction in MRE can be established. Nonetheless, there have been no cases of small bowel obstruction using sorbitol, and it is able to provide the same degree of distension.…”

Section: Discussionmentioning

confidence: 97%

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Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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Objective: To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE). Methods: This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n 5 20; psyllium, n 5 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg 21 psyllium prior to imaging.Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student's t-test and Mann-Whitney U-test.Results: Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p 5 0.338-0.908) and quantitative assessments (p 5 0.083-0.856). The mean bowel distension achieved was 20.1 6 2.2 mm for sorbitol and 19.8 6 2.5 mm for psyllium (p 5 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups. Conclusion: Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies. Advances in knowledge: This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.MR enterography (MRE) is an imaging technique used to evaluate the small bowel for diagnoses that include inflammatory bowel disease and neoplasms. Sufficiently distending the small bowel with an oral contrast agent (OCA) is critical, as collapsed loops may hide or mimic abnormalities.The OCAs employed in MRE can be classified as positive, negative or biphasic contrast agents according to their signal properties on T 1 and T 2 weighted imaging. Biphasic contrast agents typically provide low signal intensity on T 1 weighted imaging and high signal intensity on T 2 weighted imaging (T2W), and are most commonly used today because of their favourable signal characteristics for detecting bowel pathology. Water is a biphasic contrast agent, but its rapid physiological absorption from the small bowel necessitates the use of additives. These additives are often highly osmolar agents or non-osmotic agents that form hydrogels that trap water molecules in the bowel lumen. Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum. 1,2Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and eas...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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“…This was mainly due to the fact that, Psyllium is inexpensive, easy to prepare, and well-tolerated by the patients. Chen et al [ 20 ] presented four cases who developed a small bowel obstruction following the usage of Psyllium as an oral contrast in CTE and MRE. Only one of them needed operative intervention while the other three were treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

“…Only one of them needed operative intervention while the other three were treated conservatively. The authors concluded that, the presence of small bowel strictures is a risk factor for obstruction following the usage of Psyllium in the oral contrast [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Intestinal obstruction caused by a laxative drug (Psyllium): A case report and review of the literature

Hefny

Ayad²,

Matev³

et al. 2018

International Journal of Surgery Case Reports

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“…Although deaths due to poppy seed ingestion have not been reported, complications resulting from ingestion of other seed types, such as pumpkin, sunflower, psyllium seed husk (a bulk forming laxative), and sesame seeds, have been described. In many of these cases, individuals had a history of bowel stricture or narrowing, low water intake and older age . Symptoms ranged from abdominal pain and vomiting to peritonitis with ischemic bowel changes requiring surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion

Schuppener

Corliss

2017

Journal of Forensic Sciences

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Eating poppy seeds can cause a positive urine drug screen, but it is unknown whether ingesting large quantities can result in opiate intoxication or toxicity. A 54-year-old woman with intractable vomiting was found unresponsive at home and later pronounced dead. At autopsy, a cast-like large bowel obstruction composed of poppy seeds was identified. Postmortem blood morphine level was < 10 ng/mL. Cause of death was determined to be complications of a bowel obstruction secondary to poppy seed ingestion. Deaths related to eating poppy seeds have not been described in the literature. This case illustrates that consuming raw poppy seeds in large quantities did not cause lethal opiate toxicity. However, overdose deaths associated with ingesting poppy seed tea (PST) have been described. Poppy seed derivatives should be considered a potential source in cases of opiate toxicity without evidence of prescription or street drug abuse.

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Small Bowel Obstruction Following Computed Tomography and Magnetic Resonance Enterography Using Psyllium Seed Husk As an Oral Contrast Agent

Cited by 9 publications

References 24 publications

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Intestinal obstruction caused by a laxative drug (Psyllium): A case report and review of the literature

Death Due to Complications of Bowel Obstruction Following Raw Poppy Seed Ingestion

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