Computed tomographic (CT) enteroclysis refers to a hybrid technique that combines the methods of fluoroscopic intubation-infusion small bowel examinations with that of abdominal CT 1.
CT enteroclysis is complementary to capsule endoscopy in the elective investigation of small-bowel disease, with a specific role in the investigation of Crohn disease, small-bowel obstruction 1, 3, and unexplained gastrointestinal bleeding.
CT enteroclysis is considered significantly superior to conventional enteroclysis in depicting Crohn disease-associated intra- and extra-mural abnormalities 2.
CT enteroclysis utilises mainly two types of contrast :
neutral contrast media 1, 5
- these have attenuation similar to that of water, e.g. water, methyl cellulose
- intravenous contrast is used with neutral agents
- these agents allow better assessment of mucosal enhancement, mural thickness as well as mesenteric vasculature
- better used in unexplained subacute gastrointestinal bleeding due to vascular malformation and assessment of inflammatory activity and complications of small bowel Crohn’s disease
positive enteral contrast material 1, 5
- e.g. (4 to 15% water-soluble (sodium diatrizoate) solution or a dilute (1%) barium solution)
- no intravenous contrast is used with these agents
- mainly used to detect lower grades of small bowel obstruction and internal fistula
The technique of CT enteroclysis can be summarised and simplified as follows 1,5,8:
- Bowel preparation: low-residue diet, ample amount of fluids, laxative on the day prior to the examination, and nil by mouth on the day of the examination.
- Conscious sedation (optional, according to patient's preference)
- Introduction of the 12 to 14-F enteroclysis tube (under fluoroscopy or through duodenoscope). The tube tip is usually placed distal to the ligament of Treitz.
- Contrast is administered either on the fluoroscopy table or after transferring the the patient to the CT unit for commencement of the CT scan (usually 1.5-2L of oral contrast).
- In the CT unit, the position of the enteroclysis tube is checked in the topogram.
- In case negative oral contrast is to be be used, intravenous contrast injection will be given (approximately 100-150ml).
- After completing the scan, the tube is withdrawn gradually to the stomach and any extra contrast volume is suctioned.
CT in practice
- polytrauma CT
- CT CAP (chest, abdomen and pelvis)
- CT NCAP (neck, chest, abdomen and pelvis)
- head & neck
- abdomen & pelvis
- CT abdomen/pelvis
- CT abdominal aorta
- CT cholangiography
- CT colonography
- CT enteroclysis
- CT enterography
- CT gastrography
- CT KUB
- CT urogram
- CT IVU
- CT renal 4-phase/3-phase
- CT renal (lesion characterisation)
- CT renal split bolus
- CTA mesenteric vessels
- CT pancreas
- CT liver
- three phase
- CT cervical spine
- CT thoracolumbar spine
- CT whole spine
- CT shoulder
- CT pelvis
- CT hip
- CT knee
- CT ankle
- CT foot
- 1. Maglinte DD, Sandrasegaran K, Lappas JC et-al. CT Enteroclysis. Radiology. 2007;245 (3): 661-71. doi:10.1148/radiol.2453060798 - Pubmed citation
- 2. Sailer J, Peloschek P, Schober E et-al. Diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn's disease. AJR Am J Roentgenol. 2005;185 (6): 1575-81. doi:10.2214/AJR.04.1534 - Pubmed citation
- 3. Bender GN, Timmons JH, Williard WC et-al. Computed tomographic enteroclysis: one methodology. Invest Radiol. 1996;31 (1): 43-9. Invest Radiol (link) - Pubmed citation
- 4. Engin G. Computed tomography enteroclysis in the diagnosis of intestinal diseases. J Comput Assist Tomogr. 32 (1): 9-16. doi:10.1097/rct.0b013e318059bed7 - Pubmed citation
- 5. Maglinte DD, Bender GN, Heitkamp DE et-al. Multidetector-row helical CT enteroclysis. Radiol. Clin. North Am. 2003;41 (2): 249-62. - Pubmed citation
- 6. Kohli MD, Maglinte DD. CT enteroclysis in incomplete small bowel obstruction. Abdom Imaging. 34 (3): 321-7. doi:10.1007/s00261-008-9426-2 - Pubmed citation
- 7. Maglinte DD, Sandrasegaran K, Lappas JC. CT enteroclysis: techniques and applications. Radiol. Clin. North Am. 2007;45 (2): 289-301. doi:10.1016/j.rcl.2007.03.008 - Pubmed citation
- 8. Kołodziej M, Annabhani A, Sąsiadek M. CT enteroclysis in the diagnostics of small bowel diseases. Pol J Radiol. 2012;75 (2): 66-72. Free text at pubmed - Pubmed citation