Miscellaneous Applications

CT enteroclysis has been of value in resolving the false positive and false negative interpretation of non-enteral volume-challenged small bowel studies that arise from the

Table 4. CTE with neutral enteral & iv contrast

CLINICAL INDICATIONS:

1. Unexplained GI bleeding - history of prior malignancy.

2. Unexplained anemia in elderly or younger patients without diarrhea. No heme positive stool.

4. Small bowel obstruction (SBO) - no evidence of significant small bowel distention on plain film.

5. ALTERNATE EXAM - Pre- or post capsule enteroscopy or when CO2 double contrast barium enteroclysis is not technically possible (Fig. 5).

Table S. CTE (positive contrast)

1. Suspected recurrent SBO or unexplained abdominal pain with negative conventional exams or iv contrast contraindicated (Fig. 6 a-c).

2. Suspected small bowel disease (unexplained lower GI bleeding, anemia, diarrhea, and history of NSAID intake) and iv contrast contraindicated or air (CO2) Barium Enteroclysis not technically possible.

3. Subset of patients with SBO in whom general surgeons prefer conservative MX and SB distended on conventional exams.

4. SBO in the immediate post operative period.

5. History of prior abdominal surgery for malignant tumor.

6. History of prior radiation therapy.

7. Crohn's disease with prior surgery.

difficulties associated with small bowel non-filling, poor distention, peristalsis, or the simulation of wall thickening or pseudowaves caused by retained fluid that occurs with positive oral contrast [12]. In patients with symptoms of proximal small bowel obstruction, the performance of the CT enteroclysis with the catheter tip in the descending duodenum have resulted in more precise diagnosis.

Capsule Endoscopy Plain Film

Fig. 5. Neutral enteral contrast CTE in a 63-year-old female with unexplained gastrointestinal (GI) bleeding. Wireless capsule endoscopy showed jejunal angioectasia (not shown). CTE showed a 3 cm hypervascular submucosal mass (arrow) arising from mid small bowel, proven to be a gastrointestinal stromal tumor at surgery

Fig. 5. Neutral enteral contrast CTE in a 63-year-old female with unexplained gastrointestinal (GI) bleeding. Wireless capsule endoscopy showed jejunal angioectasia (not shown). CTE showed a 3 cm hypervascular submucosal mass (arrow) arising from mid small bowel, proven to be a gastrointestinal stromal tumor at surgery

We have observed abdominal pain and nausea in patients with irritable bowel syndrome due to the high infUsion rates used with CT enteroclysis. This may be an important clinical observation once organic disease has been excluded [12]. Prompt adjustment of the infusion rate can diminish the discomfort without problems. Neutral enteral contrast is not seen fluoroscopically, so CT enteroclysis with this method is subject to difficulties that arise when evaluating non-distended bowel in patients that vomit or inadvertently lose small bowel contrast via the rectum. Experience and adherence to technical details alleviates this disadvantage.

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