Routine use of modified CT Enterography in patients with acute abdominal pain.
OBJECTIVE
To evaluate routine use of CT Enterography (CTE) in patients presenting with non-traumatic acute abdominal pain with respect to patient tolerance, imaging of intestinal detail along with conventional abdominal evaluation.


METHODS
Modified CTE was performed in 165 consecutive patients with acute abdominal pain: ingestion, as tolerated, of 900-1200 ml of 2% barium suspension + 5 ml of Gastrografin over 45 min; 150 ml of iv contrast given in two boluses (50 and 100 ml) 3 min apart (split bolus injection protocol). Axial, coronal and sagittal reformats were reviewed by two radiologists and graded on a 5-point scale (5 best) in regard to GI tract luminal opacification and distension and abdominal organ and vascular enhancement.


RESULTS
In 81 patients the cause of abdominal pain was identified (intestinal in 54 and extraintestinal in 27). Oral contrast reached cecum in 76% of the patients and the small bowel was well distended and opacified (medians=4). Mucosa detail was good (median=3) and there was significant (p<0.0001) correlation between bowel opacification and distension for both jejunum and ileum. A combined nephrographic and excretory phase was achieved (medians 4 and 5, respectively), while the great vessels were well opacified, allowing for vascular evaluation (median=5). The rest of the abdominal structures were well visualized.


CONCLUSIONS
Modified CTE is well tolerated by patients with acute non-traumatic abdominal pain, and can be used routinely as a non-invasive examination informative of bowel, vessel and organ pathology in Emergency Department patients.
Gourtsoyianni
Sofia
S
Department of Radiology, University Hospital of Heraklion, Medical School of Crete, 71110 Stavrakia, Heraklion/Crete, Greece. sgty76@gmail.com
Zamboni
Giulia A
GA
Romero
Janneth Y
JY
Raptopoulos
Vassilios D
VD
D015746:Abdominal Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging*; D007422:Intestines / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
D003287:Contrast Media; D001466:Barium Sulfate