CT enteroclysis in the developing world: How we do it, and the pathology we see

Introduction: Imaging and diagnosis of small bowel disease is challenging, especially in developing countries where access to supplementary imaging equipment is not readily available. Imaging of the small bowel has evolved from small bowel follow-through to the first enteroclysis by Pesquera in 1929. This technique evolved over time with advances in enteral intubation catheters, enteral contrast media and techniques for infusing enteral contrast. Objective: (1) Describe our modification of performing CTE and (2) to show pathology and discuss its relevance in our clinical practice. Materials and methods: This was a retrospective study that included 73 patients since the introduction of our modified technique of performing CT enteroclysis (CTE) using saline vaculitres, intravenous line connection sets and a drip stand. We recorded patient data in Microsoft Corporation Excel 2007 to include indications for the CTE, patient demographics and imaging findings related to small bowel pathology with associated extra luminal findings and incidental extra-intestinal non small bowel findings that was statistically analyzed. Results: Of the 73 patients included in the study 42 where females and 31 males. 15 (20.5%) had small bowel pathology and 12 (16.4%) had non-small bowel pathology that could explain the clinical symptoms. Malabsorption/chronic diarrhea group was the largest indication for referral (26% of referrals). Most prevalent small bowel findings were in the inflammatory bowel subgroups where 30% had imaging features of active inflammatory bowel disease. Conclusion: Decades of experience have shown that only small bowel examinations that uniformly distend the small bowel lumen can confidently confirm or rule out small bowel pathology. With our modified technique performed, with readily available and affordable infusion equipment and enteral contrast we achieve diagnostic quality small bowel distention to demonstrate and diagnose with confidence small bowel pathology in our population. This is of particular value in developing countries where we are resource limited and expensive equipment and contrast material is often not available