Optimal timing for faecal tagging in same day CT colonography for patients with failed colonoscopy.

AIM: Same day CT colonography (CTC) for incomplete colonoscopy should be considered to avoid the need for further bowel preparation. Oral administration of contrast is essential for optimal colonic analysis of the CTC. Our aim was to determine the optimal time for giving contrast to people who underwent same day CTC after failed colonoscopy. METHODS: Data was extracted from the Trust database to identify the number of CTC referrals following failed or incomplete colonoscopy within the last 5 years, and the reason for their referral. Patients were then excluded if they had not received faecal tagging, which included all patients prior to 2013. Two experienced radiologists independently reviewed the CTCs to determine the level of faecal tagging, and this was correlated with the estimated length of time between the administration of the contrast agent and the CTC examination. RESULTS: 110 patients were identified within the 5 year period who had undergone same day CTC following failed colonoscopy. Reasons for the referral included incomplete colonoscopy (most common indication), contraindication to colonoscopy, poor colonoscopic view, refusal for colonoscopy and data unavailable. 60 patients had received faecal tagging, and two experienced radiologists independently reviewed these CTCs to determine the level of faecal tagging from the caecum to the rectum (complete bowel coverage). CONCLUSION: Our study suggests that contrast should be given approximately 256.4 ± 24.4 (4.27 h) minutes before same day CTC, but this time could be reduced where the left side of the colon had been successfully evaluated by colonoscopy. Further studies with multicentre collaborations are required.

Radiation exposure in patients with inflammatory bowel disease--primum non nocere?

BACKGROUND: Patients with Inflammatory Bowel disease (IBD) are frequently exposed to diagnostic medical radiation for the diagnosis and evaluation of their disease. Despite increasing awareness of the potentially serious downstream effects, few studies have quantified radiation exposure in IBD patients. METHODS: We conducted a retrospective review of 280 consecutive patients attending IBD clinics at our hospital. All incidences of diagnostic medical radiation from initial diagnosis until 30 June 2010 inclusive were recorded. The radiation dose for each procedure was obtained from standardized tables and the effective dose for each procedure calculated by multiplying this value by the number of procedures during the study period. The sum of doses received was the cumulative effective dose. RESULTS: The mean and median cumulative effective radiation doses were 10.17 mSv and 4.12 mSv respectively. Crohn's disease patients had significantly higher cumulative effective radiation exposure than UC patients (p < 0.001) with exposure exceeding 10 mSv in 58.3%, 25 mSv in 18.1% and 50 mSv in 6.3%, respectively. Smoking status, disease duration, and previous surgery were significant predictors for increased radiation exposure even after adjusting for other predictors. 47 small bowel magnetic resonance (MR) studies were undertaken as an alternative to ionising radiation in the last 3 years. CONCLUSIONS: Patients with IBD, particularly those with Crohn's disease, are exposed to significant amounts of diagnostic medical radiation in their lifetime. Clinicians must remain vigilant to the risk of cumulative radiation when evaluating these patients and consider non-ionizing alternatives such as intestinal ultrasound and MR imaging where clinically appropriate.

Cystic lymphangioma of the mesocolon.

A 46-year-old gentleman presented to our hospital with a short story of abdominal pain and distension. On examination, gross ascites was noted and confirmed on subsequent imaging with no other notable features. CT scan after ascitic drainage showed a cystic mass extending from the lower pole of the spleen to the left iliac fossa in keeping with an intraperitoneal cyst. At laparatomy, a cystic lymphangioma was resected. Lymphangiomas are rare benign tumours and are reported to occur preferentially in the neck of axilla in children. Abdominal lymphangiomas are extremely rare particularly in adults but important to recognise due to a potential for serious consequences.