The demise of the instant/unprepared contrast enema in large bowel obstruction.
OBJECTIVE
Imaging the colon in suspected acute large bowel obstruction (LBO) is traditionally carried out with a supine abdominal X-ray (AXR) and erect chest X-ray. If there is no clinical or radiological evidence to suggest a perforation, then an unprepared barium or water-soluble contrast enema (CE) can be performed to confirm the presence of and demonstrate the site of obstruction. The advent of modern, fast multidetector CT (MDCT) scanners has changed management strategies for acute abdominal conditions including suspected LBO in all groups of patients especially the elderly, infirm and those on ITU/HDU.


METHODS
A retrospective case note analysis was carried over a 7-year period in a single centre. The study criteria involved investigation of suspected LBO with CE, CT and MDCT.


RESULTS
It showed a reduction in the number of contrast enemas performed.


CONCLUSIONS
MDCT was shown to be more accurate in the diagnosis of LBO, is usually available on a 24-h basis, and in many institutions has replaced the urgent CE in this group of patients. This also has the advantage of excluding incidental findings and in staging malignant disease.
Jacob
S E
SE
Department of Surgery, Manchester Royal Infirmary, Manchester, UK. shareenebeth@yahoo.co.uk
Lee
S H
SH
Hill
J
J
D003108:Colonic Diseases / Q000000981:diagnostic imaging*; D003112:Colonic Pseudo-Obstruction / Q000000981:diagnostic imaging; D023881:Colonography, Computed Tomographic / Q000639:trends*; D003287:Contrast Media; D004733:Enema / Q000639:trends*; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D006113:United Kingdom
D003287:Contrast Media