Manuel Vega-Sillero¹, Michaela Sojak¹, Cesar Sanchez Jimenez^2,3

¹Lumbry Park Veterinary Specialists, Alton, United Kingdom. ²VIMOS, Manchester, United Kingdom. ³Anderson Moores Veterinary Specialists, Winchester, United Kingdom

Objectives

To evaluate the feasibility of administering low-concentration intraluminal iohexol for the detection of intestinal leakage in gastrointestinal wall perforations.

Methods

Three canine cadavers (10–23.3 kg) were included. A 6 mm incision was created in the proximal duodenum to simulate a perforation.

Cadaver 1 was used to establish the minimum contrast concentration required for leakage detection. Iohexol was administered via an orogastric Foley catheter, starting at 50 mgI/kg diluted in 10 mL/kg of saline. Incremental increases in iohexol dose were performed, with serial CT studies acquired immediately following each administration. Imaging was repeated until intestinal leakage of contrast to the peritoneum was identified using a soft tissue reconstruction algorithm.

Cadavers 2 and 3 were used to determine the minimum volume required for leakage detection. Boluses of 2.5 mL/kg saline containing iohexol were administered via an orogastric Foley catheter. Serial CT studies were performed following each bolus, as described above, until intestinal leakage was identified.

Results

Intestinal leakage of iohexol was detected at a minimum dose of 180 mgI/kg diluted in 30 mL/kg of saline, corresponding to a concentration of 2%.

The minimum total volume required to visualise intestinal leakage ranged from 30 to 34 mL/kg.

Statement: Impact/ Clinical Significance

The presence of peritoneal iohexol can be detected at a total concentration of 2%, which is considered safe based on previous experimental studies demonstrating no adverse effects on peritoneal or renal morphology and function at concentrations below 2.5%.

This technique could benefit patients with equivocal gastrointestinal perforation.

Radiography may represent a feasible alternative imaging modality.