Visible Urinary Tract Excretion Following Oral Administration of Water-Soluble Contrast Media

Publisher Website
Google Scholar
Abstract
Water-soluble iodinated contrast media such as Hypaque are being administered orally with increasing frequency for suspected intestinal obstruction, perforated peptic ulcer, etc. It has been stated by several authors that these substances are rarely absorbed from the normal adult gastrointestinal tract and that visible urinary tract excretion usually indicates either an abnormal intestinal mucosa or perforation and absorption of Hypaque from the peritoneal cavity (1,2). Recently, at the Los Angeles County General Hospital, a patient was admitted with signs and symptoms suggesting perforated peptic ulcer. An upper gastrointestinal examination with Hypaque gave no evidence of peptic ulceration or perforation, but the bladder was opacified. This was considered positive evidence of intestinal perforation, and an exploratory laparotomy was carried out. At surgery the gastrointestinal tract was normal. As a result of this occurrence, a study was undertaken to determine the incidence of visible urinary excretion of Hypaque following oral administration in apparently healthy patients. Materials and Methods One hundred consecutive examinations of the gastrointestinal tract were performed on ambulatory patients. Their complaints were in all instances insufficient to require hospitalization. Cases of known malignancy, possible bowel ischemia, or previous intestinal perforation were excluded from the study. Of those examined, 53 were females and 47 were male. They ranged in age from fourteen through eighty-two, with an average of forty-seven. Powdered Hypaque2 (diatrizoate sodium) was prepared in a 30 per cent solution and flavored with cherry syrup. A routine upper gastrointestinal examination was performed with 240 cc of contrast medium. Additional roentgenograms of the abdomen and pelvis were obtained at thirty-minute intervals for three hours and evaluated for urinary tract excretion. The studies were reviewed by two independent observers. Only those considered positive by both were taken to represent visible urinary excretions. Discussion In a review of 200 upper gastrointestinal examinations utilizing water-soluble iodinated contrast media, Shehadi noted no radiographic evidence of urinary excretion (3). Several authors then suggested that recognizable urinary tract opacification in the adult following such a study constitutes almost certain evidence of breech of the intestinal mucous membrane (1, 2). Mori and Barrett reported 5 cases of bladder opacification following gastrointestinal perforation. These included appendiceal perforation, leakage at the anastomotic site following partial gastrectomy, an esophageal perforation, and 2 cases of colon perforation with abscess formation. A sixth case of bladder opacification was observed in which no intestinal perforation was evident at surgery. After oral administration of Hypaque, we noted visible urinary tract excretion in 17 per cent of the ambulatory patients. The excretion was graded as + in 11 cases, as ++ in 5, and as +++ in 1.

This publication has 0 references indexed in Scilit: