CT enteroclysis (protocol)
Updates to Article Attributes
Computed tomographic (CT) enteroclysis refers to a hybrid technique that combines the methods of fluoroscopic intubation-infusion small bowel examinations with that of abdominal CT 1.
Indications
CT enteroclysis is complementary to capsule endoscopy in the elective investigation of small-bowel disease, with a specific role in the investigation of Crohn disease, small-bowel obstruction 1, 3,3, and unexplained gastrointestinal bleeding.
CT enteroclysis is considered significantly superior to conventional enteroclysis in depicting Crohn disease-associated intra- and extra-mural abnormalities 2.
Technique
CT enteroclysis utilises mainly two types of contrast:
-
neutral contrast media 1
, 5,5- these have attenuation similar to that of water, e.g. water, methyl cellulose
- intravenous contrast is used with neutral agents
- these agents allow better assessment of mucosal enhancement, mural thickness as well as mesenteric vasculature
- better used in unexplained subacute gastrointestinal bleeding due to vascular malformation and assessment of inflammatory activity and complications of small bowel Crohn
’sdisease
-
positive enteral contrast material1
, 5,5-
e.g.
(44 to 15% water-soluble (sodium diatrizoate) solution or a dilute (1%) barium solution) - no intravenous contrast is used with these agents
- mainly used to detect lower grades of small bowel obstruction and internal fistula
-
e.g.
Procedure
The technique of CT enteroclysis can be summarised and simplified as follows 1,5,8:
-
Bowelbowel preparation: low-residue diet, ample amount of fluids, laxative on the day prior to the examination, and nil by mouth on the day of the examination. -
Consciousconscious sedation (optional, according to patient's preference) -
Introductionintroduction of the 12 to 14-F enteroclysis tube (under fluoroscopy or through duodenoscope). The, the tube tip is usually placed distal to the ligament of Treitz. -
Contrastcontrast is administered either on the fluoroscopy table or after transferring the the patient to the CT unit for commencement of the CT scan (usually 1.5-2L-2 L of oral contrast). -
Inin the CT unit, the position of the enteroclysis tube is checked in the topogram. -
Inin case negative oral contrast is to be be used, intravenous contrast injection will be given (approximately 100-150ml-150 mL). -
Afterafter completing the scan, the tube is withdrawn gradually to the stomach and any extra contrast volume is suctioned.
See also
-<p><strong>Computed tomographic (CT) enteroclysis</strong> refers to a hybrid technique that combines the methods of fluoroscopic intubation-infusion small bowel examinations with that of abdominal CT <sup>1</sup>.</p><h4>Indications</h4><p>CT enteroclysis is complementary to <a href="/articles/capsule-endoscopy">capsule endoscopy</a> in the elective investigation of small-bowel disease, with a specific role in the investigation of <a href="/articles/crohn-disease-1">Crohn disease</a>, <a href="/articles/small-bowel-obstruction">small-bowel obstruction</a> <sup>1, 3</sup>, and unexplained gastrointestinal bleeding.</p><p>CT enteroclysis is considered significantly superior to conventional enteroclysis in depicting Crohn disease-associated intra- and extra-mural abnormalities <sup>2</sup>.</p><h4>Technique</h4><p>CT enteroclysis utilises mainly two types of contrast :</p><ul>- +<p><strong>Computed tomographic (CT) enteroclysis</strong> refers to a hybrid technique that combines the methods of fluoroscopic intubation-infusion small bowel examinations with that of abdominal CT <sup>1</sup>.</p><h4>Indications</h4><p>CT enteroclysis is complementary to <a href="/articles/capsule-endoscopy">capsule endoscopy</a> in the elective investigation of small-bowel disease, with a specific role in the investigation of <a href="/articles/crohn-disease-1">Crohn disease</a>, <a href="/articles/small-bowel-obstruction">small-bowel obstruction</a> <sup>1,3</sup>, and unexplained gastrointestinal bleeding.</p><p>CT enteroclysis is considered significantly superior to conventional enteroclysis in depicting Crohn disease-associated intra- and extra-mural abnormalities <sup>2</sup>.</p><h4>Technique</h4><p>CT enteroclysis utilises mainly two types of contrast:</p><ul>
-<strong>neutral contrast media </strong><sup>1, 5</sup><ul>- +<strong>neutral contrast media </strong><sup>1,5</sup><ul>
-<li>better used in unexplained subacute gastrointestinal bleeding due to vascular malformation and assessment of inflammatory activity and complications of small bowel <a href="/articles/crohn-disease-1">Crohn’s disease</a>- +<li>better used in unexplained subacute gastrointestinal bleeding due to vascular malformation and assessment of inflammatory activity and complications of small bowel <a href="/articles/crohn-disease-1">Crohn disease</a>
-<strong>positive enteral contrast material<sup> </sup></strong><sup>1, 5</sup><ul>- +<strong>positive enteral contrast material<sup> </sup></strong><sup>1,5</sup><ul>
-<strong></strong>e.g. (4 to 15% water-soluble (<a href="/articles/sodium-diatrizoate">sodium diatrizoate</a>) solution or a dilute (1%) barium solution)</li>- +<strong></strong>e.g. 4 to 15% water-soluble (<a href="/articles/sodium-diatrizoate">sodium diatrizoate</a>) solution or a dilute (1%) barium solution</li>
-<li>Bowel preparation: low-residue diet, ample amount of fluids, laxative on the day prior to the examination, and nil by mouth on the day of the examination.</li>-<li>Conscious sedation (optional, according to patient's preference)</li>-<li>Introduction of the 12 to 14-F enteroclysis tube (under fluoroscopy or through duodenoscope). The tube tip is usually placed distal to the <a title="Ligament of Treitz" href="/articles/ligament-of-treitz">ligament of Treitz</a>.</li>-<li>Contrast is administered either on the fluoroscopy table or after transferring the the patient to the CT unit for commencement of the CT scan (usually 1.5-2L of oral contrast).</li>-<li>In the CT unit, the position of the enteroclysis tube is checked in the topogram.</li>-<li>In case negative oral contrast is to be be used, intravenous contrast injection will be given (approximately 100-150ml).</li>-<li>After completing the scan, the tube is withdrawn gradually to the stomach and any extra contrast volume is suctioned.</li>- +<li>bowel preparation: low-residue diet, ample amount of fluids, laxative on the day prior to the examination, and nil by mouth on the day of the examination</li>
- +<li>conscious sedation (optional, according to patient's preference)</li>
- +<li>introduction of the 12 to 14-F enteroclysis tube (under fluoroscopy or through duodenoscope), the tube tip is usually placed distal to the <a href="/articles/ligament-of-treitz">ligament of Treitz</a>
- +</li>
- +<li>contrast is administered either on the fluoroscopy table or after transferring the the patient to the CT unit for commencement of the CT scan (usually 1.5-2 L of oral contrast)</li>
- +<li>in the CT unit, the position of the enteroclysis tube is checked in the topogram</li>
- +<li>in case negative oral contrast is to be be used, intravenous contrast injection will be given (approximately 100-150 mL)</li>
- +<li>after completing the scan, the tube is withdrawn gradually to the stomach and any extra contrast volume is suctioned</li>