DOI: 10.1148/radiol.2323040268
(Radiology 2004;232:937.)
Oral Use of Gadopentetate Dimeglumine for Anastomotic Leak in Patients with Iodine Sensitivity
Alexander R. Margulis, MD,*,
Yong Ho Auh, MD,* and
Michel Gagner, MD
Departments of Radiology* and Surgery, Weill Medical College, Cornell University, 525 East 68th Street, Box 141, New York, NY 10021. e-mail: arm2001@med.cornell.edu
Editor:
Oral administration of water-soluble iodinated contrast material is the accepted method of determining whether leakage is occurring at new anastomotic sites in the upper gastrointestinal tract. This is often followed by the ingestion of barium if no leak is demonstrated.
While allergic reactions to oral ionic iodinated contrast media are exceedingly rare (1), leakage of contrast material into soft tissues or the peritoneal cavity can produce adverse reactions in patients who are sensitive to them, and barium spillage from an anastomotic leak is most undesirable (2).
The problem of marked, life-threatening allergy to substances containing iodine was recently avoided at our institution in a patient who was allergic to iodine. The patient was a morbidly obese individual (weighing close to 500 lbs [225 kg]) who had undergone morbid obesity surgery. The ingestion of 40 mL of gadopentetate dimeglumine chelate provided sufficient opacity for diagnostic purposes. The contrast material used has proved to be safe for intravenous use in magnetic resonance imaging (3).
Figures 1 and 2 illustrate this approach.
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Figure 1. Opacity comparison of gadopentetate dimeglumine (left), diatrizoate meglumine (center), and water (right) in small 20-mL glass bottles. Radiograph was obtained with 120 kVp and 200 mA.
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Figure 2a. Upright fluoroscopic spot images. (a) Gadolinium chelate in gastric pouch entering the patient’s gastric "sleeve." (b) Barium in the esophagus before entering the gastric pouch. Opacity difference between the barium in the esophagus and gadolinium chelate in the gastric pouch is evident.
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Figure 2b. Upright fluoroscopic spot images. (a) Gadolinium chelate in gastric pouch entering the patient’s gastric "sleeve." (b) Barium in the esophagus before entering the gastric pouch. Opacity difference between the barium in the esophagus and gadolinium chelate in the gastric pouch is evident.
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REFERENCES
- Sidhu PS, Dawson P. Adverse reactions: cause, prophylaxis and management. In: Dawson P, Cosgrove DO, Grainger RG, eds. Textbook of contrast media. Oxford, England: Isis Medical Media, 1999; 99-119.
- Gharehmani GG. Iatrogenic gastrointestinal disorders. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. 2nd ed. Philadelphia, Pa: Saunders, 2000; 2238-2239.
- Brasch RC, Weinmann HJ, Wesbey GE. Contrast-enhanced NMR imaging: animal studies using gadolinium-DTPA complex. AJR Am J Roentgenol 1984; 142:625-630.[Abstract/Free Full Text]
