metrizamide and Intestinal-Perforation

Although the diagnosis of bowel perforation is frequently straightforward, it may be difficult in the neonate. Clinical signs may be limited to abdominal distension. If the patient is on assisted ventilation, pneumoperitoneum may be due to air tracking down from the chest rather than perforation. The authors report 6 cases of bowel perforation in infants in whom the diagnosis could not readily be made from the clinical findings and plain radiographs but was apparent when oral metrizamide was employed. This suggests that metrizamide can be a valuable adjunct in some cases of neonatal bowel perforation.

Topics: Diagnosis, Differential; Humans; Infant, Newborn; Intestinal Perforation; Metrizamide; Pneumoperitoneum; Radiography; Ventilators, Mechanical

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

Pneumoperitoneum in the neonate may be due to air that has dissected from the chest. Four infants, in whom pneumoperitoneum, from thoracic air dissection, occurred in the absence of pneumothorax or pneumomediastinum are reported. The absence of abnormal collections of air in the chest is of no value in deciding whether a pneumoperitoneum is due to bowel perforation or air dissecting from the chest. Contrast bowel studies are needed in all cases of pneumoperitoneum in the infant to distinguish bowel perforation from intrathoracic origin of the air.

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Laparotomy; Metrizamide; Pneumoperitoneum; Radiography, Thoracic