Technical failure of water-soluble contrast challenge

Case contributed by Dr Vikas Shah

Presentation

Recent bowel surgery. CT shows dilated small bowel loops, consistent with low grade early post-operative adhesions. Gastrografin challenge study.

Patient Data

Age: 70 years
Gender: Female

AXRs at 6 hours

X-ray

Two large bore surgical drains in situ. Nasogastric tube. All of the contrast is in the stomach.

No satisfactory clinical progression. Persistent high output from the nasogastric tube. Repeat AXRs to check for passage of previously administered contrast through the small bowel, no further contrast was administered.

AXR at 72 hours

X-ray

No contrast seen in the stomach, small bowel or large bowel. Surgical drains and NG tube remain in situ.

Case Discussion

The complete absence of contrast indicates that it is very likely the Gastrografin has been suctioned out by the nasogastric tube early in the course of the water-soluble contrast challenge. It is recommended that if a nasogastric tube is in situ during this type of study, it should be allowed to be on free suction for at least two hours prior to administration of the contrast to allow gastric decompression. Once the contrast has been administered, the nasogastric tube should be clamped for two hours. This ensures that the contrast is not immediately suctioned out of the stomach by the NG tube after the contrast is administered.

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