Case of the Month March 2014, page 6

Answer: a) IV contrast only. Note that this is a subject of much confusion among physicians. It is important to remember that oral contrast is NOT appropriate in the setting of suspected high grade obstruction. To quote the ACR: “Oral contrast should not be used if high grade SBO is known or suspected. Oral contrast will not reach the site of obstruction, wastes time, adds expense, can induce further patient discomfort, will not add to diagnostic accuracy, and can lead to complications, particularly vomiting and aspiration.”

Also note that ordering a CT does not necessarily require you as the clinician to specify what kinds of contrasts to be used. You may write “contrast at radiologist’s discretion” (along with a detailed indication) and a radiologist will protocol the study according to appropriateness criteria and your clinical question.

The patient says she has been able to keep fluids down today in spite of feeling nauseated, and has been passing stool.  A CT of the abdomen and pelvis with IV and oral contrast is performed. What is the main finding?
a) appendicitis
b) intussusception
c) normal examination
d) typhlitis

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