Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus

PURPOSE: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. METHODS: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight < 1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. RESULTS: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9–34.3 weeks) and 893 g (range, 610–1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3–11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1–6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1–14 days) after the procedure. CONCLUSION: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.

Three Cases of Terminal-stage Ovarian Cancer in Which Diatrizoate Meglumine and Diatrizoate Sodium Solution (Gastrografin) Treatment for Gastrointestinal Symptoms of Malignant Bowel Obstruction Was Effective

<p>We report three cases of terminal-stage ovarian cancer where diatrizoate meglumine and diatrizoate sodium solution (Gastrografin) was effective for malignant bowel obstruction due to peritoneal dissemination. All cases had gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and constipation, showed air-fluid levels and dilation of the small intestine on imaging tests. Therefore, all the cases were diagnosed as bowel obstruction. We initiated oral administration of Gastrografin because the patients failed to show a sufficient response to other drugs such as octreotide. Their gastrointestinal symptoms such as nausea and constipation improved after administration of the drug, and they could continue oral intake. In addition, they were diagnosed as having an incomplete bowel obstruction since radiographic examination 24 hours after administration of Gastrografin confirmed its presence in the large intestine. In all the cases, Gastrografin could be used repeatedly without noticeable side effects. This study suggests that Gastrografin might be useful for evaluating bowel obstruction and improving gastrointestinal symptoms in patients with malignant bowel obstruction caused by terminal-stage ovarian cancer.</p>

Water as neutral oral contrast agent in abdominopelvic CT: comparing effectiveness with Gastrografin in the same patient

Introduction: Positive oral contrast is no longer deemed necessary for abdominopelvic computed tomography (CT) scans. Studies have shown water to be an equally effective oral contrast agent. However, to our knowledge no study has compared effectiveness between gastrografin and water in the same patient, which will provide a more objective evaluation of the two oral contrast agents. We aim to make a head-to-head comparison of water as neutral oral contrast (OC) against gastrografin as positive OC for abdominopelvic CT scans in the same patient. Methods: A retrospective review of 206 abdominopelvic CT scans of 103 patients was performed. The scans were reviewed in consensus by two blinded radiologists. The ability to visualise each abdominopelvic organ, contrastassociated artefacts and small bowel wall delineation, was qualitatively scored on a 5-point scale. Each patient had two sets of scores, one with water and another with gastrografin as OC. Paired scores from the two OCs were evaluated by Wilcoxon signed rank test to determine any significant difference in performance between the two OCs for visualisation of abdominopelvic anatomy on CT. Results: There was significantly better delineation of duodenal wall (p<0.001) and overall visualisation of the duodenum (p=0.011) using water as OC compared to gastrografin. No statistically significant differences were demonstrated between water and gastrografin for visualisation of the rest of the abdominopelvic organs, walldelineation of the rest small bowel and contrast-associated artefacts. Conclusions: Water can be used in place of gastrografin as oral contrast in abdominopelvic CT without compromising visualization of abdominopelvic organs.

A Case of Dissolution of Barium-impaction by Gastrografin / 대한소아소화기영양학회지

Ileus caused by impaction of hardened residual barium stagnated in the colon, a rare complication of barium-enema examination, constitutes a particularly serious problem when it occurs in congenital megacolon patients. The administration of gastrografin in such case has proven efficacy in dissolution of impacted barium refratory to routine means of evacuation. We experienced a case of barium-impaction occurred in 6-months old male who had congenital megacolon. Gastrografin enema was a safe and simple method used in the management of this case.