CT ENTEROCLYSIS

Introduction 

CT Enteroclysis is an advanced imaging procedure that combines the use of enteral contrast material with Computed Tomography (CT) to obtain detailed images of the small intestine. It is primarily used for the evaluation of small bowel tumours, Crohn’s disease, obscure gastrointestinal symptoms and motility disorders. 

What is CT Enterocolitis? 

This procedure comprises the infusion of either neutral or low-density contrast into the small bowel through a Naso jejunal tube, followed by CT imaging. Such synergy improves the distension of the small bowel and aids in the evaluation of the bowel wall and mucosa with cross sectional and three-dimensional reconstructed images.

• Bowel wall thickness and enhancement 
• Presence of stricture, ulcer and masses 
• Amount of disease involvement and its location 
• Outermost complication (fistula, abscess, lymph nodes) 

• Evaluate small bowel pathology 
• Treat symptoms effectively, especially in Crohn’s disease 
• Distinguishing inflammatory from neoplastic disease 
• Evaluate treatment effects 

When and Who Needs a CT Enteroclysis? 

Indications: 

• Ongoing or unclear gastrointestinal bleeding 
• Expected or validated Crohn’s disease 
• Assessment of small bowel cancerous lesions. 
• Abdominal pain without any findings in endoscopy or colonoscopy 
• Surgical assessment after bowel surgery (e.g. adhesion, stricture) 

Patient Demographics: 

• Patients above the age of 12 with chronic gastrointestinal conditions. 
• Individuals with confirmed or suspected inflammatory bowel issues. 
• Patients who have undergone abdominal surgery with recurrent symptoms. 
• Patients with malignancy requiring bowel assessment. 

Benefits of Taking the Test

• Visualization of the small bowel in high-resolution and detail. 
• Useful for detecting complex or subtle pathologies. 
• Provides a 3D perspective which helps in making surgical or therapeutic decisions. 
• Requires less time and is less invasive compared to traditional methods of enterocytic. 

Conditions Diagnosed

• Crohn’s disease, and ulcerative jejunoileitis. 
• Small bowel tumours (adenocarcinoma, lymphoma, carcinoid). 
• Intestinal tuberculosis and other infectious. 
• Post-surgical adhesions and obstruction. 
• Celiac disease with its complications. 

• Fasting for 6-8 hours. 
• Stopping medicines responsible for constipation such as iron supplements. 
• Follow the provided bowel cleansing instruction. 

Pre-requisites 

• If IV contrast is planned, recent kidney function tests are needed. 
• Informed patient consent especially for nasojejunal intubation. 
• Previous imaging and medical records need to be checked. 

Best Time to Take the Scan 

• After discussing the purpose, and clinical necessity the scan can then be scheduled, radiology will decide if they have time. 
• Morning times are preferable to facilitate pre and post procedure work. 

Eligibility 

• Most patients are considered safe for this procedure. 
• Those with a perforated bowel, severe obstruction, or contrast allergic reactions must be approached with caution. 

Procedure 

• Naso jejunal tube placement under fluoroscopy/endoscopy. 
• Enteral contrast is slowly infused to inflate the small bowel. 
• The CT scan is conducted at the peak inflation stage. 
• IV contrast injection may be done to enhance the detail but remains optional. 
• Forensic analysis in image reconstruction 

Caution 

• Watch for signs of nausea, abdominal discomfort, or bloating during the infusion of the contrast agent. 
• Alert the radiologist regarding the obstruction or allergy history.