A 23 year old female patient presented to the ER with RLQ pain s/p appendectomy.

Question

A 23 year old female patient presented to the ER with RLQ pain s/p appendectomy. The physicians are concerned for a suspected perforation and would like to evaluate her GI tract.

Diabetic- takes Metformin

No Known Allergies.

Patient is unsure of her last menstrual cycle.

What test ex should be performed? What type of contrast should be used? Does the patient need to have lab work prior to the scan? If so, what type? Where should the IV go and what size should it be? What is the scan delay for the exam? Any special instructions for the patient after the scan?

Explanation / Answer

Bowel perforation is the emergency condition where the intestinal contents are drained into the peritonial cavity. Immediate attention should be required. The best way to detect the perforation is CT scan with IV contract of Abdomen.

The type os contrast used is water soluble contrast especially iodine and barium.

Instructions for the patients with Diabetic for CT scan are

Hold the metformin for 48 hours after the scan.

Before testing look for the sensitivity for contrast materials.

Should not eat or drink water 4 hours before scan.

General vitals should be recorded..

The IV contrast will go to the peritonial cavity through vessels and the structures are visualized.

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