From the Guidelines
Yes, you can order a CT scan with oral contrast for a patient with a gastric sleeve, as it is the study of choice in patients with a previous history of bariatric surgery presenting with acute abdomen. According to the operative management of acute abdomen after bariatric surgery guidelines 1, contrast-enhanced CT scan with oral contrast is recommended. When ordering the CT scan, special considerations are needed, such as reducing the standard oral contrast volume to accommodate the smaller gastric capacity, usually to about 300-500 mL. The timing between contrast administration and imaging may need adjustment as gastric sleeve patients have accelerated gastric emptying. Water-soluble iodinated contrast agents like Gastrografin or dilute barium sulfate are commonly used. It's essential to ensure adequate hydration before and after the procedure, especially if the patient has compromised renal function. The radiologist should be informed about the patient's gastric sleeve status to properly interpret the images, as the altered anatomy will affect the normal appearance of the stomach. This approach allows for appropriate visualization while accommodating the anatomical changes from bariatric surgery. Key considerations include:
- Reducing oral contrast volume to 300-500 mL
- Adjusting timing between contrast administration and imaging
- Using water-soluble iodinated contrast agents
- Ensuring adequate hydration
- Informing the radiologist about the patient's gastric sleeve status As stated in the guidelines 1, this approach is supported by moderate-quality evidence, making it a suitable choice for patients with a gastric sleeve.
From the Research
CT Scan with Oral Contrast for Gastric Sleeve Patients
- There is no direct evidence to suggest that a CT scan with oral contrast is contraindicated for patients with gastric sleeve 2, 3.
- However, the use of oral contrast agents in patients with gastric sleeve may be limited due to potential complications such as gastric leak or stenosis 2.
- Studies have shown that abdominal CT scans can be preferred over upper gastrointestinal (UGI) contrast studies in the presence of clinical suspicion of postoperative complications 2.
- The choice of oral contrast agent may be important, with some studies suggesting that low-osmolar iodinated solutions such as iohexol may be better tolerated by patients than high-osmolar contrast mediums or barium sulfate suspensions 4, 5, 6.
- Patient tolerance and preference for oral contrast agents can vary, with some studies showing that patients prefer the taste of iohexol over other agents 5, 6.
Oral Contrast Agents for CT Scans
- Iohexol is a low-osmolar iodinated solution that can be used as an oral contrast agent for CT scans 4, 5, 6.
- Studies have shown that iohexol is well-tolerated and provides good opacification of the bowel 5, 6.
- Other oral contrast agents such as diatrizoate sodium and barium sulfate suspensions may also be used, but may have a worse taste and more adverse effects than iohexol 4, 5, 6.
Gastric Sleeve Patients and CT Scans
- Gastric sleeve patients may undergo CT scans with oral contrast to evaluate for postoperative complications such as gastric leak or stenosis 2, 3.
- The radiologic patterns after sleeve gastrectomy can vary, with some patients showing immediate unhindered flow of contrast through the sleeve and others showing delayed flow 3.
- Patient tolerance of fluid intake after gastric sleeve surgery can be predicted by the radiologic appearance on postoperative day 1 3.