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Is oral and IV contrast necessary in CT for the evaluation of children with suspected appendicitis?
- CT for appendicitis requires IV contrast to detect inflammation due to appendicitis or various other causes, but oral contrast is not necessary for the diagnosis of appendicitis.
- There is an increasing body of evidence that shows that there is no diagnostic compromise in those children who undergo CT without oral contrast for suspected appendicitis.
- In fact, diagnostic performance of CT without oral contrast has been found to be equivalent or better compared to CT with oral contrast.
- There is a high percentage of patients that do take oral contrast for whom the contrast does not even reach the point of interest, the terminal ileum, prior to the CT.
- In addition, delayed diagnostic evaluation, frequency of emesis after contrast bolus, and the need for a nasogastric tube to tolerate the bolus all limit the efficacy of oral contrast for CT.
Sources
Anderson BA, Salem L, Flum DR: A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg 2005;190:474-478.
Laituri, Fraser JD, Aguayo P, et al: The lack of efficacy for oral contrast in the diagnosis of appendicitis by computed tomography. J Surg Res 2011;170:100-103.
