CT ENTEROCLYSIS

A CT Enteroclysis is a specialized, minimally invasive diagnostic imaging test designed to provide your doctor with a clear and comprehensive view of your small intestine. At Cadabam's diagnostics, we use this advanced procedure to obtain highly detailed, cross-sectional images of the small bowel, offering a level of detail that is superior to a standard abdominal CT scan for evaluating specific intestinal conditions. This examination is crucial for diagnosing and managing complex gastrointestinal issues, helping to guide your treatment and bring you closer to an accurate diagnosis.

Types of CT Enteroclysis

The core procedure for CT Enteroclysis remains consistent, but the type of contrast agent used can be adjusted based on the clinical question your doctor is trying to answer. For instance, a "neutral" contrast agent (like water) is excellent for highlighting how the bowel wall enhances after IV contrast, which is crucial for assessing inflammation. A "positive" contrast agent (which appears bright white on the scan) may be used in other specific situations.

It's also important to differentiate this test from a CT Enterography. In CT Enterography, the patient drinks a large volume of contrast material over about an hour. While also effective, CT Enteroclysis is often preferred because the direct tube infusion ensures faster, more reliable, and more complete distention of the entire small bowel, often leading to superior diagnostic results.

After your scan is complete, a highly trained radiologist will meticulously analyze the hundreds of images produced. They are trained to look for specific signs of disease and abnormalities. Key parameters they evaluate include:

• Bowel Wall Thickness and Enhancement: Healthy bowel walls are thin. Thickening and increased brightness ("enhancement") after IV contrast suggest active inflammation.
• Strictures: These are fixed areas where the bowel has become abnormally narrowed, which can be caused by scarring or inflammation.
• Fistulas and Abscesses: The scan can detect abnormal tunnels (fistulas) connecting the bowel to other organs or pockets of infection (abscesses), which are serious complications of conditions like Crohn's disease.
• Polyps or Tumors: Abnormal growths protruding from the bowel lining can be clearly identified.
• Comb Sign: An abnormality in the blood vessels supplying the bowel, which can indicate severe inflammation.
• Mesenteric Changes: The radiologist also examines the surrounding fat and connective tissue (the mesentery) for signs of inflammation or disease spread.

Your physician will order a CT Enteroclysis based on a combination of your symptoms, medical history, and results from previous tests. Common symptoms that may lead to this test include:

• Chronic or Severe Diarrhea: Persistent diarrhea that has not been explained by other diagnostic tests.
• Unexplained Abdominal Pain and Cramping: Especially when the pain is centered around the navel or in the lower right abdomen.
• Significant, Unintentional Weight Loss: Losing weight without trying can be a sign of a serious underlying digestive issue.
• Anemia: A low red blood cell count that may be caused by slow, hidden blood loss (obscure GI bleeding) within the small intestine.
• Symptoms of Malabsorption: Signs that your body is not properly absorbing nutrients, such as bloating, fatigue, and specific vitamin deficiencies.

When and Who Needs to Take a CT Enteroclysis?

Your doctor may recommend a CT Enteroclysis if you have persistent or unexplained symptoms related to your small intestine, and other diagnostic tests have not provided a clear answer. This test is particularly valuable for:

• Diagnosing and Monitoring Crohn's Disease: It is one of the most effective tests for assessing the extent and severity of inflammation, strictures, and complications associated with Crohn's disease.
• Investigating Unexplained Gastrointestinal Bleeding: When the source of bleeding is suspected to be in the small bowel and endoscopy has not found it.
• Detecting Small Bowel Tumors: It can identify polyps, benign tumors, and malignant masses that are difficult to see with other methods.
• Evaluating Complicated Celiac Disease: For patients who are not responding to a gluten-free diet or are suspected of having complications.
• Assessing for Small Bowel Obstruction: It can help identify the location and cause of a blockage.

This test is often performed on individuals who have long-standing, unexplained symptoms such as chronic abdominal pain, diarrhea, or weight loss.

Benefits of Taking the Test

Choosing to undergo a CT Enteroclysis offers numerous benefits for your diagnostic journey:

• Definitive Diagnosis: It provides a highly accurate and definitive diagnosis for many conditions that are difficult to pinpoint with other imaging or endoscopic methods.
• Guides Treatment: The detailed results help your doctor determine the severity and extent of your condition, allowing them to create the most effective treatment plan, whether it involves medication, lifestyle changes, or surgical intervention.
• Surgical Planning: If surgery is necessary, the images act as a roadmap for the surgeon, showing the exact location and extent of the problem.
• Non-Surgical Examination: It offers a comprehensive, non-surgical way to visualize the entire 20 feet of the small intestine, an area that is largely inaccessible to standard endoscopes.

Illnesses Diagnosed with CT Enteroclysis

This powerful diagnostic tool is instrumental in identifying and managing a range of small bowel diseases, including:

• Crohn's disease
• Small bowel lymphoma and other tumors (benign and malignant)
• Small bowel obstruction and adhesions (scar tissue)
• Complications of Celiac disease
• Meckel's diverticulum
• Ischemic bowel disease
• Sources of obscure gastrointestinal bleeding

Proper CT enteroclysis preparation is essential for ensuring the highest quality images. Please follow these instructions carefully.

Diet

You will need to follow a clear liquid diet for the entire day before your scheduled test. Clear liquids include water, clear broth, black coffee or tea (no milk or cream), and clear juices like apple or white grape juice. You must be NPO (nothing by mouth, including water) for at least 6-8 hours before your appointment time.

Medication

Continue to take your prescribed medications unless instructed otherwise by your doctor. If you are diabetic, especially if you take Metformin, please discuss specific instructions with your referring physician or our staff, as you may need to adjust your dosage.

Clothing

On the day of the test, wear comfortable, loose-fitting clothing. Avoid clothing with metal zippers, snaps, or buttons in the abdominal area. You may be asked to change into a hospital gown.

Arrival

Please plan to arrive at Cadabam's diagnostics a little early to allow time for registration and to complete any necessary paperwork.

Pre-requisites

• You must have a referral (doctor's order) from your physician to schedule a CT Enteroclysis.
• To ensure your kidneys can safely process the IV contrast dye, you may be required to have a recent blood test to check your kidney function (Creatinine/eGFR). Please bring any recent lab results with you.

Best Time to Take the CT Enteroclysis

A CT Enteroclysis is performed by appointment only at Cadabam's diagnostics. There is no specific time of day that is medically superior for undergoing the test. We will work with you to find an appointment time that fits your schedule.

Eligibility

Most adults are eligible for a CT Enteroclysis, particularly those who can tolerate the nasojejunal tube placement. However, there are some contraindications. You may not be eligible if you:

• Are or might be pregnant. Radiation can be harmful to a developing fetus.
• Have severe kidney failure. Your kidneys may not be able to clear the IV contrast dye from your system.
• Have a known severe allergy to iodine or previous CT contrast materials.

It is crucial to discuss your full medical history with your doctor and our staff before the procedure.

Procedure for Taking a CT Enteroclysis

Our compassionate team at Cadabam's diagnostics will guide you through every step. Here is the CT enteroclysis procedure explained:

Step 1 - Tube Placement

The procedure begins in a special room equipped with an X-ray machine (fluoroscope). A technologist will numb your nose and the back of your throat with a local anesthetic spray. They will then gently guide the thin, flexible tube through one nostril, down your esophagus, through your stomach, and into the beginning of your small intestine. The technologist uses the live X-ray images to ensure correct placement.

Step 2 - Contrast Infusion

You will then be moved to the CT scanner and positioned comfortably on the scanner table. The external end of the tube is connected to a pump that will slowly infuse the liquid contrast material into your small bowel, causing it to expand for the scan.

Step 3 - IV Contrast

In most cases, you will also receive an injection of a different type of contrast dye into a vein in your arm. This IV contrast helps to highlight blood vessels and the walls of your organs, providing additional diagnostic information. You may feel a warm sensation as it is injected; this is normal.

Step 4 - Scanning

The CT scanner table will move you through the large, donut-shaped machine. The scanner will rotate around your abdomen, capturing detailed images. To get the clearest pictures, the technologist will ask you to hold your breath for a few seconds at a time.

Step 5 - Completion

Once all the images have been acquired, the scan is complete. The technologist will then quickly and gently remove the tube from your nose. The entire process, from tube placement to the end of the scan, typically takes about 45 to 60 minutes.

Caution Before Taking the Test

For your safety, you must inform the technologist before your scan begins if you:

• Are pregnant, think you might be pregnant, or are breastfeeding.
• Have any allergies, especially to medications, iodine, shellfish, or a previous reaction to X-ray contrast dye.
• Suffer from any kidney disease, kidney failure, or have had a kidney transplant.
• Have diabetes and are taking Metformin (also known as Glucophage, Fortamet, etc.).
• Have a history of asthma or heart conditions.