In this study the attention was focused on the possible application of the new low-osmolar water-soluble
contrast media in already existing routines for radiologic diagnostic work-up and management of the abdominal emergencies of simple
intestinal obstruction and
ischemia:
Iohexol was a good, or better, alternative to
sodium diatrizoate regarding taste acceptance and patient reactions: Seventy-five per cent of patients characterized the taste of
iohexol as good or neutral, while 52% gave
sodium diatrizoate similar scores. The scores were also consistently in favor of
iohexol as compared with
sodium diatrizoate for the other chosen criteria;
nausea,
vomiting and
diarrhea, but a larger number of patients may be needed for conclusive evaluation. Water-soluble media may have
therapeutic effects on
intestinal obstruction when preceded by conventional gastric suction using a short gastric tube: Twenty-three of 25 patients with subtotal small bowel obstruction due to peritoneal adhesions improved following the ingestion of either
iohexol or
sodium diatrizoate. Hyperosmolar
contrast media might stimulate peristalsis and dilute the bowel contents, hence, easing the passage through a subtotally obstructed bowel. In rats, a direct relationship was found between contrast medium osmolality and the degree of intestinal distension, fluid influx to the bowel lumen and the speed of contrast medium progression. The water-soluble, low-osmolar
contrast media seem promising as diagnostic
aids in examination of the gastrointestinal tract: The low-osmolar
contrast media gave better intestinal details on films than both
barium sulphate and
sodium diatrizoate in rats with
intestinal obstruction or
ischemia when high volumes of radiopaques were employed. Also in patients
iohexol retained its radiographic density in the small bowel better than
sodium diatrizoate. The diagnostic efficacy of the water-soluble radiographic media varied directly with their osmolality and the resulting fluid influx to bowel lumen. Hyperosmolality stimulated contrast medium progression and bowel distension, and reduced the radiographic density of the
contrast media and the alignment to the bowel wall. Water-soluble
contrast media may aid the diagnosis of bowel
ischemia and the evaluation of the degree of ischemic injury: No bladder opacification, following absorption of water-soluble
contrast media from the simply obstructed bowel, was observed in the majority of the animals and was only faintly present in 8%. Distinct radiographic opacification of the urinary bladder in rats with intestinal
ischemia was demonstrated as early as 1-2 hours after the administration of contrast medium.(ABSTRACT TRUNCATED AT 400 WORDS)