Use of Oral Contrast Material in Whole Body Trauma CT

Transcription

1 Use of Oral Contrast Material in Whole Body Trauma CT Nordic Trauma Radiology Course May 2006 Henrik Teisen MD Dept. of Radiology Svendborg Hospital Denmark.

2 Un-enthusiastic Radiology/Unsatisfied Patient ORAL CONTRAST IN TRAUMA CT Why use oral contrast? Which contrast material? When and how to administer oral contrast? Is it safe? Pitfalls Results

3 + OC - OC Fast diagnosis CT with OC accurate Centers using OC detect more injuries Delineates anatomy Detects leakage Focus on B-M Safe Delayed diagnosis? Time consuming? Aspiration? Nausea Vomiting No solid evidence Useless Whereis thesalmon?

4 Oral Contrast enhanced anatomy Duodenum:hematoma,wall thickness Pancreas: edema Small bowel: hematoma, wall injury, contusion of bowel, interloop fluid Mesentery: infiltration, hematoma Free fluid References Mirvis, AJR 1992 Fakhry, J Trauma 2000 : Diagnostic delay in B-M injuries increases mortality. Shanmuganathan, AJR 2001 : Tripple Contrast in penetrating trauma. Malhotra, J Trauma 2000 : Killeen, J Trauma 2001 : Butela, AJR 2001 : CT with OC is accurate in detecting B-M injuries.

5 References Trauma Radiology Workshop Sweden 2001 : Seems that those using OC pick up more B-M injuries Bernstein, Advanced CT, Diagnostic Imaging Janzen, Clinical Radiology 1998 Numerous Trauma Centers use OC according to protocol Oral Contrast Material Barium sulfate : Too radiodense producing artifacts and not preferable in case of leakage Water based iodine: 300MgI/ml diluted to a 3-5% solution Water: Can be used, misses leakage

6 Oral Contrast - Who? All blunt thoracic and abdominal trauma Children: 2/3 of blunt thoracic trauma have abdominal injury Standard procedure: Oral contrast is administered by the trauma nurse as soon as possible after admittance. How? drink it or given by oro/nasogastric tube Volume: 400ml-? NO other procedure should be delayed Diagnosis?

7 Interloop free fluid Water in Duodenum

8 OC Excellent anatomy OC

9 OC Duodenal Duodenum

10 OC free fluid-duodenal injury Full thickness duodenal injury

11 Diagnosis without OC? Free Fluid

12 Duodenal & Jejunal injury Bowel-Mesenteric injury Incidence 0,5 8,5% Non-op management > missed B-M injuries Symptoms are often delayed Diagnostic delay increases mortality

13 Results OC 6 years 900 ptt no aspiration ISS > 15 18,7% Thoracic-abdominal-pelvic 73,8% Bowel-mesenteric injury 3,8% Free fluid unaccounted for 6,0% OC - Amount No OC 14,2% Less than 400ml 18,2% ml 18,7% More than 600ml 23,1% Unknown 19,6%

14 Results : OC passage Stomach 2,7% +Small bowel proximal 24,0% +Small bowel ileum 39,6% Empty stomach +small bowel 11,7% Non-OC 15,1% No patients 223 OC nice distribution

15 OC in eviscerated bowel OC - Concerns Aspiration Undiluted contrast ph 5 Diluted contrast ph 6 2 cases of aspiration: 1 had a nasogastric tube in right mainstem bronchus 1 c-spine immobil.patient aspirated OC

16 References Federle, Radiology 1997 : 510 patients : OC is safe. Nastanski, Injury 2001 : 1173 patients, 1 aspirat. Lim-Dunham, AJR 1997 : No aspiration after OC in Children at Trauma CT Wolfe, Acad Emerg Med 2003 : Non-OC-CT may be inadequate Stafford, Arch Surg 1999 : OC unnecessary and delays treatment OC Reviewing : ml OC is sufficient 15% did not have OC: non-abd trauma Facial injury Patient refusal 4 patients vomited -12 experienced nausea No patients showed signs of aspiration

17 OC duodenal hematoma OC free fluid-hematoma-jejunal injury

18 OC jejunal transsection Ileum Injury

19 OC in Bowel-not Free Fluid Extraluminal OC

20 Oral contrast Pitfalls Extraluminal contrast: Vascular or bowel injury? Inflammatory intestinal disease Shock bowel Artifacts Disturbing later x-rays of thoracic/lumbar spine and pelvis Bowel Contusion-Free Fluid

21 I.V. and OC.

22 Happy customer Oral Contrast : Conclusion Helps to outline abdominal structures Detects leakage and bowel wall injury Draws attention to bowel and mesentery Seems to detect B-M injury better than non-oc Easy to administer Often excellent passage Safe Pitfalls Thank you for your attention!

23 You will succeed! Sundown in Gotland

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25 Shock Bowel - Colon lesion OC jejunal transsection

26 OC freepelvicfluid What do you see?

27 OC in Ileum Free Fluid

28 Extensive mesenteric injury Bowel Injury

29 Free Fluid Free Fluid