Small bowel perforation with fistula to anterior abdominal wall
Multiple previous bowel operations. Recent surgery for adhesional small bowel obstruction. Discharge from wound now contains feces-like material. CT to rule out enterocutaneous fistula.
CT abdomen and pelvis with intravenous and oral contrast
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In addition to intravenous contrast, 500 ml of 5% Gastrografin was given 30 minutes before image acquisition. This has leaked from the small bowel in the pelvis into a cavity, which itself communicates with the anterior abdominal wall at the lower end of the midline laparotomy wound. Oral contrast is seen within the wound itself as well as a drainage bag overlying the abdominal wall. The bowel loops in the lower abdomen and pelvic look thick-walled, raising the possibility that there is ischemia. Further thick-walled collections developing in the pelvis.
At repeat surgery, the cavity was washed out and the perforated small bowel was resected. This case illustrates the benefit of administering oral contrast in certain specific scenarios, such as when seeking to identify an enterocutaneous fistula. Imaging of drain bags overlying wounds is important, as the only sign of an enterocutaneous fistula may be the presence of oral contrast within the drain bag.