Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
J Surg Res. 2011 Sep;170(1):100-3. doi: 10.1016/j.jss.2011.02.017. Epub 2011 Mar 12.
Oral contrast is often used with computed tomography (CT) for the diagnosis of appendicitis. This adjunct adds time to evaluation, not all patients can tolerate enteric bolus, and the diagnostic advantages have not been well defined. Therefore, we reviewed our experience to evaluate the impact of oral contrast on diagnostic efficiency and its impact on the patient.
After obtaining IRB approval, a retrospective review was conducted on patients who underwent CT with oral contrast for the indication of appendicitis over the last 4 years. Data recorded included demographics, CT results, emergency room course, operative findings, and pathology interpretation. All images were reviewed to identify presence/absence of contrast at or beyond the terminal ileum.
There were 1561 patients, of whom, 652 (41.8%) were diagnosed with appendicitis and 909 (58.2%) were not (non-appendicitis). Contrast was identified at least to the level of the terminal ileum in 72.4% of the entire population. The contrast was present in 76.2% of the non-appendicitis patients and 67.0% of the appendicitis patients (P = 0.01). Mean time from oral contrast administration to CT imaging was 105.5 min, which was longer in patients with appendicitis (112.2 min) compared with non-appendicitis patients (100.9 min) (P = 0.01). Emesis of the contrast occurred in 19.3% of those with appendicitis and 12.9% of those without appendicitis (P = 0.001). Nasogastric tubes were placed in 5.8% of those with appendicitis and 5.1% of those without (P = 0.37). Appendicitis was confirmed at operation in 94.3% of those with contrast in the area and 94.4% of those without (P = 1.0). Pathology confirmed appendicitis in 90.6% of those with contrast in the area and 94.0% of those without (P = 0.17).
Nearly 30% of patients receiving oral contrast for the CT diagnosis of appendicitis do not have contrast in the point of interest at the expense of emesis, nasogastric tube placement, and diagnostic delay. These detriments are amplified in patients who have appendicitis. Further, there appears to be no diagnostic compromise in those without contrast in the terminal ileum.
口服造影剂常用于计算机断层扫描（CT）诊断阑尾炎。这种辅助手段增加了评估时间，并非所有患者都能耐受肠道造影剂，且其诊断优势尚未明确。因此，我们回顾了经验，以评估口服造影剂对诊断效率的影响及其对患者的影响。
获得机构审查委员会批准后，对过去 4 年因阑尾炎指征行 CT 检查并口服造影剂的患者进行回顾性分析。记录的数据包括人口统计学、CT 结果、急诊室就诊情况、手术结果和病理解读。所有图像均进行了回顾，以确定是否在回肠末端或其以上部位存在造影剂。
共 1561 例患者，其中 652 例（41.8%）诊断为阑尾炎，909 例（58.2%）非阑尾炎。整个人群中至少有 72.4%的患者在回肠末端有造影剂。非阑尾炎患者中有 76.2%的患者有造影剂，而阑尾炎患者中有 67.0%（P=0.01）。从口服造影剂给药到 CT 成像的平均时间为 105.5 分钟，阑尾炎患者（112.2 分钟）比非阑尾炎患者（100.9 分钟）长（P=0.01）。有 19.3%的阑尾炎患者和 12.9%的非阑尾炎患者呕吐造影剂（P=0.001）。有 5.8%的阑尾炎患者和 5.1%的非阑尾炎患者需要放置鼻胃管（P=0.37）。在有造影剂的区域，手术证实阑尾炎的比例为 94.3%，无造影剂的区域为 94.4%（P=1.0）。在有造影剂的区域，病理证实阑尾炎的比例为 90.6%，无造影剂的区域为 94.0%（P=0.17）。
近 30%的因 CT 诊断阑尾炎而接受口服造影剂的患者在回肠末端没有造影剂，代价是呕吐、放置鼻胃管和诊断延迟。这些不利因素在患有阑尾炎的患者中更为明显。此外，在回肠末端没有造影剂的患者中，似乎没有诊断上的缺陷。
