Clinical Indications

The clinical applications of the two modifications of CT enteroclysis overlap. In our early experience, we used CTE with positive enteral contrast for most small bowel investigations of possible small bowel obstruction (Fig. 3a, 3b). Since the introduction of multislice CT technology, we use CT enteroclysis with neutral enteral and iv contrast as our primary method of investigation when the small bowel is not distended, as determined by the scout radiograph, and when there is no contraindication to the use of iv iodinated contrast. This modification is faster, reproducible and allows a more global detailed evaluation

Table 3. CT Parameters

• Quad CT (MX 8000, Philips Medical Systems)

3.2 mm slice width

1.3 mm reconstruction interval

• Brilliance 16 channel CT (MX 8000 IDT, Philips Medical Systems)

2.0 mm slice width

1.0 mm reconstruction interval

• Brilliance 40 or 64 (Philips Medical Systems) Scan 40 x 0.625 mm

Post process: COR [email protected] 4 mm SAG

• Source raw images workstation for interpretation

Fig. 3. A 38-year-old male with prior appendicectomy presenting with intermittent abdominal pain. a Conventional CT image showed no evidence of distended small bowel. b CTE with positive enteral contrast, performed three days later, showed distended proximal bowel loop with abrupt tapering of caliber (arrowhead) adjacent to anterior parietal peritoneum. Distal small bowel contains enteral contrast but was non-distended (arrow). Low-grade obstruction was diagnosed and surgically proven as being due to adhesions

Fig. 3. A 38-year-old male with prior appendicectomy presenting with intermittent abdominal pain. a Conventional CT image showed no evidence of distended small bowel. b CTE with positive enteral contrast, performed three days later, showed distended proximal bowel loop with abrupt tapering of caliber (arrowhead) adjacent to anterior parietal peritoneum. Distal small bowel contains enteral contrast but was non-distended (arrow). Low-grade obstruction was diagnosed and surgically proven as being due to adhesions not only of the small intestine, but also of the entire abdomen. It is well tolerated by patients if simple technical guidelines are observed and uses less radiation than positive enteral contrast.

Table 4 summarizes the current clinical indications of CTE with neutral enteral and iv contrast. Table 5 summarizes the current clinical indications of CTE with positive enteral contrast.

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