ARRS 2022 Abstracts

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E1693. CT Examination of the Abdomen and Pelvis: When and Why Rectal Contrast-Enhancement is Necessary
Authors
  1. Dylan Hoyt; St. Josephs Hospital and Medical Center
  2. Olga Kalinkin; St. Josephs Hospital and Medical Center
  3. Matthew Wagner; St. Josephs Hospital and Medical Center
Objective:
We conducted an observational retrospective study to investigate rectal contrast-enhanced CT abdomen and pelvis (rce-CTAP) examination indications, category of patients, ordering physician specialty, and result of the examination on decision of surgical versus conservative treatment in the home institution.

Materials and Methods:
The database 'Montage' was searched for the key words: 'rectal contrast' and 'CT abdomen, pelvis' performed by the radiology department of our tertiary medical center between 2014 and 2019. Retrospective analysis of the rce-CTAP examination clinical query, patient population demographics, CT report final diagnosis, and subsequent clinical management was done.

Results:
There were 209 rce-CTAP studies included in the study; 102 patients were female and 107 were male, with an age range of 19–95 years. Of these studies, 134 exams were ordered STAT, and the remaining 75 were routine exams. A total of 167 patients who were imaged in the hospital, 32 patients were in outpatient clinics, and 10 patients were in the emergency department. One hundred thirty-seven of the rce-CTAP studies were ordered by general and colorectal surgeons; 44 were ordered by internal medicine, 24 were ordered by emergency medicine, and 4 were ordered by gynecology. Indications for rce-CTAP were grouped into the following clinical categories: suspicion for colorectal perforation (39 examinations), anastomotic bowel leak (23), possible abscess (38), fistula (29), and impending or high grade distal colonic obstruction (80). All clinical queries were ruled out in 151 patients, and clinical suspicion was confirmed in 58 patients after the rce-CTAP examination. Taking into the account the results of the rce-CTAP, surgery was performed in 57 patients and 152 patients were managed conservatively.

Conclusion:
rce-CTAP examination of the abdomen and pelvis is a powerful tool for colorectal and general surgeons to assess for presence or absence of colonic perforation, anastomotic leak, fistula, abscess, or impending distal colonic obstruction in hospitalized patients. The rectal contrast-enhanced CT examination confidently stratifies hospitalized patients to surgical or conservative treatment.