Presentation
Difficult colonic resection 15 years earlier, post-operative wound complications, long standing discharge from wound in midline. Being investigated for possible enterocutaneous fistula.
Patient Data
The anterior abdominal wall is deficient above the level of the umbilicus, with small bowel loops approaching the surface. A small volume of inflammatory change is present adjacent to small bowel close to the surface. Satisfactory appearances of the anastomosis. Incidental right adrenal myelolipoma.
As the first CT did not definitively identify an enterocutaneous fistula, he was recalled for a repeat CT with oral contrast, but no intravenous contrast. 800 ml of 5% Gastrografin was administered slowly over 60 minutes prior to imaging. The contrast opacifies the stomach and small bowel and delineates a fistula to the anterior abdominal wall. Contrast has pooled on the surface of the dehiscent anterior abdominal wall, and is within the stoma bag used to drain the wound. The fistulous loop is ileal.
Case Discussion
This case illustrates the utility of oral contrast for the detection and localization of enterocutaneous fistulae. 800 ml of 5% Gastrografin drunk slowly over 60 minutes prior to imaging is palatable, provides the appropriate contrast density, and is safe.
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