metrizamide and Intestinal-Obstruction

This article is intended to update the general surgeon on and inform the general surgical resident of new concepts in pediatric bowel obstruction. Specifically, newer diagnostic modalities are discussed, and more emphasis is directed toward diagnoses that the general surgeon is more apt to encounter.

Topics: Child, Preschool; Dehydration; Duodenal Obstruction; Female; Fluid Therapy; Humans; Hypertrophy; Infant; Intestinal Obstruction; Intussusception; Male; Medical History Taking; Metrizamide; Physical Examination; Postoperative Complications; Pyloric Stenosis; Radiography, Abdominal; Stomach; Stomach Volvulus; Suture Techniques; Tissue Adhesions; Ultrasonography

Topics: Child, Preschool; Digestive System; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Metrizamide; Radiography

Topics: Administration, Oral; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Atresia; Intestinal Obstruction; Metrizamide; Radiography

The finding of a gasless abdomen on the abdominal radiograph of an infant over 12 hr old is usually abnormal and may reflect a serious pathologic disorder. Accurate diagnosis is important to plan appropriate therapy. A careful review of the clinical history and the plain chest and abdominal radiographs will often permit an accurate diagnosis to be made. In cases where the diagnosis remains in doubt, contrast studies of the bowel with metrizamide have proved helpful. This report presents six infants with gasless abdomens of unknown cause. In each case, a metrizamide contrast study of the bowel was helpful in providing an accurate diagnosis.

Topics: Child, Preschool; Enterocolitis, Pseudomembranous; Female; Gases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intestines; Male; Metrizamide; Radiography; Urinary Bladder Diseases

Metrizamide is the first water-soluble radiographic contrast agent which, because it is nonionic, can be used in isotonic solution and gives good visualization of the desired body structure. Its only major disadvantage is that it is very expensive. Metrizamide can be used to study the neonatal bowel in clinical situations where all the other existing contrast agents are contraindicated. The results of 55 metrizamide studies of the bowel in infants are reviewed. In necrotizing enterocolitis metrizamide aids in confirming or rejecting the diagnosis, identifying patients for surgery, and in evaluating the response to surgery. Metrizamide can identify the etiology in unusual cases of bowel obstruction. Metrizamide correctly identified a thoracic origin of free peritoneal air in four cases and a bowel origin in two cases. It identified bowel perforation in two patients in the absence of pneumoperitoneum. In six patients, the metrizamide study identified the cause for a gasless abdomen. It is concluded that metrizamide has a valuable role to play in evaluating a variety of neonatal bowel disorders.

Topics: Drug Evaluation; Enterocolitis, Pseudomembranous; Humans; Infant, Newborn; Intestinal Obstruction; Intestinal Perforation; Intestines; Metrizamide; Radiography

Metrizamide (Amipaque) has been used to image the bowel of four neonates and one older child with possible bowel obstruction. In each case, barium and hypertonic water-soluble agents, such as Gastrografin and Hypaque, were contraindicated. In each case, the metrizamide study provided unique formation altering the management of the patient. Metrizamide provides a new method of evaluating selected difficult cases of suspected bowel obstruction in the newborn, and in older children it may help to distinguish between postoperative ileus and mechanical obstruction.

Topics: Child; Humans; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Male; Metrizamide; Radiography

Nine adult patients with complete obstruction of the colon on barium enema examination were evaluated after oral administration of Amipaque. This water-soluble iodinated contrast material proved useful in the diagnosis of obstructive lesion, outlining the narrowed segment and the more proximal colon. There were no side effects.

Topics: Administration, Oral; Adult; Aged; Barium Sulfate; Colonic Diseases; Enema; Female; Humans; Intestinal Obstruction; Male; Metrizamide; Middle Aged; Radiography