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Contrast Enema Before Bypass Surgery for Small-Bowel Obstruction in the Oncologic Patient: Is It Necessary?

Keith D. Hentel1 and Marc J. Gollub2

1 Department of Radiology, New York-Presbyterian Hospital, 525 E 68th St., New York, NY 10021.
2 Department of Radiology, Memorial Sloan-Kettering Cancer Center, Rm. C276F, 1275 York Ave., New York, NY 10021.



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  		Fig. 1A. —63-year-old woman with stage IV ovarian carcinoma. Axial CT scan shows high-grade partial small-bowel obstruction, with air- and fluid-dilated loops of small bowel and collapsed distal loops. Note the contrast material (arrow) in left colon. Peritoneal implants (arrowheads) are also present.

 


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  		Fig. 1B. —63-year-old woman with stage IV ovarian carcinoma. Axial CT scan shows peritoneal and serosal disease (arrow) involving sigmoid colon. However, colon remains nondistended as result of more proximal obstruction.

 


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  		Fig. 1C. —63-year-old woman with stage IV ovarian carcinoma. Spot radiograph from water-soluble enema shows severe narrowing (arrows) of sigmoid colon and dilatation of colon proximal to the obstruction, consistent with mechanical obstruction.

 


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  		Fig. 2A. —42-year-old woman with stage IV gastric carcinoma who presented with nausea and vomiting. Axial CT scan shows multiple loops of air- and fluid-filled small bowel, consistent with obstruction.

 


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  		Fig. 2B. —42-year-old woman with stage IV gastric carcinoma who presented with nausea and vomiting. Axial CT scan reveals findings suggestive of serosal disease. However, colon is decompressed as result of more proximal obstruction.

 


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  		Fig. 2C. —42-year-old woman with stage IV gastric carcinoma who presented with nausea and vomiting. Spot radiograph from water-soluble contrast enema shows complete distal bowel obstruction corresponding to site of disease shown in B. This finding allowed patient to be treated with diverting colostomy to bypass both proximal and distal small-bowel obstructions at initial surgery.

 


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  		Fig. 3. —70-year-old man with stage IV pseudomyxoma who presented with small-bowel obstruction diagnosed on CT. Spot radiograph from water-soluble contrast enema shows filling of stomach from transverse colon, revealing presence of unsuspected gastrocolic fistula (arrow).

 

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