The use of non-ionic water-soluble contrast agents for small bowel follow-through examination

Abstract

In certain situations it is preferable to perform small bowel examination using water-soluble contrast agents. Generally, ionic agents are used, but non-ionic agents may be an alternative in certain circumstances. We retrospectively reviewed a consecutive series of small bowel examinations using non-ionic media in order to determine their efficacy. A total of 52 water-soluble non-ionic small bowel follow-through examinations were performed in 42 patients using 100 ml iohexol. Indications for the study and the reasons why barium sulphate suspensions were contraindicated were established. Studies were assessed for radiographic quality and clinical findings were noted, and comparison was made with operative findings and clinical outcome. Obstruction was diagnosed in 12 examinations and the radiological findings were confirmed in all 7 patients surgically treated. Fistulae were identified in 11 examinations and the radiological findings were confirmed in all 8 patients who were treated by laparotomy. Additionally, at laparotomy no obstruction or fistula was found in the 5 patients in whom prior contrast examination had been negative. Non-ionic water-soluble follow-through examination is easily performed and well tolerated, allowing accurate diagnosis of obstruction and fistula when barium suspensions are contraindicated.

High-Output Fistula

“…Diagnosis is almost as accurate as with barium studies but there is less definition, especially with more distal lesions. 19 Water-soluble contrast examinations through the rectum or in retrograde fashion from stomas can also be highly contributory.…”

The sequelae of barium aspiration

“…Non-ionic water-soluble contrast, such as iopromide, is safer on aspiration compared to barium and gastrograffin. 4,5 However, they will require larger volumes to define the oesophageal anatomy. The surgeon should weigh the risks and benefits of a barium contrast in a patient with risk of aspiration.…”