Oral contrast for abdominal and pelvic CT

Background

  • Oral contrast considerations for patients undergoing CT of abdomen and/or pelvis
  • Pros: May add improved imaging characteristics for some patient groups
  • Cons: Requires significant "lead time" (i.e. must administer >1hr prior to CT scan) and can result in delays to care

Indications for Oral Contrast

Desirable

  • Suspected fistula or bowel leak
  • Suspected intussusception or internal hernia

May Consider

  • Suspected low-grade bowel obstruction[1]
    • For suspected high-grade bowel obstruction, oral contrast is contra-indicated (wastes time, adds expense, can induce further patient discomfort, will not add to diagnostic accuracy, and can lead to complications, particularly vomiting and aspiration)[1]
  • Intra-abdominal abscess depending on the suspected primary source
    • May not be required if primary source is skin infection
  • Metastatic evaluation
  • Suspected Hernia
  • Appendicitis or Diverticulitis with BMI <20
    • "Oral or rectal contrast may not be needed depending on institutional preference."[1]
    • "Evidence is trending against the routine use of oral contrast, and particularly against the routine use of rectal contrast, for CT when IV contrast is used."[1]

Redypaque Dose

Weight

Give 1 hour prior to scan

Give 30 minutes prior to scan

Give immediately upon arrival to CT

< 2 kg

None or as ordered by physician

None or as ordered by physician

None or as ordered by physician

2-5 kg

30 mL

30 mL

30 mL

>5-20 kg

90 mL

90 mL

90 mL

>20-50 kg

150 mL

150 mL

150 mL

>50 kg

300 mL

300 mL

300 mL

(100cc/age)/3 = dose x 3

Max = 300cc

See Also

References

  1. 1.0 1.1 1.2 1.3 American College of Radiology ACR Appropriateness Criteria® https://acsearch.acr.org/docs/69476/Narrative/

Authors:

Michael Holtz