Incidence of clinically significant perforation at low dose non-contrast CT and its value prior to same day CT colonography following incomplete colonoscopy

• Published in: Abdominal imaging Vol. 45; no. 4; pp. 1044 - 1048
• Main Authors: O’Shea, Aileen, Murray, Timothy, Morrin, Martina M., Lee, Michael J., Thornton, Eavan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2020; Springer Nature B.V
• Subjects: Adequacy; Adult; Aged; Clinical significance; Colitis; Colon; Colon - diagnostic imaging; Colonography, Computed Tomographic; Colonoscopy; Colonoscopy - statistics & numerical data; Colorectal cancer; Contrast Media; Diatrizoate Meglumine; Female; Gastroenterology; Hepatology; Humans; Identification methods; Imaging; Incidence; Intestine; Male; Medicine; Medicine & Public Health; Middle Aged; Pelvis; Perforation; Practice; Radiology; Retrospective Studies; Risk Factors; Same day CT colonography; CT colonography; Optical colonoscopy; Colorectal cancer
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-019-02062-8

Purpose Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at preceding incomplete colonoscopy, before further gaseous insufflation at CTC. The aim of our study is to examine the incidence of clinically significant perforation at low dose CT. We also examine the benefits of low dose pre-scan in assessing adequacy of bowel preparation and identifying any other relevant contraindications to CT colonography. Materials and methods We conducted a retrospective review of all low dose non-contrast CTs performed following failed colonoscopies over a 4-year period ( n  = 392). We also assessed the adequacy of bowel preparation on a scale of 1–5, in order of increasingly adequate preparation. Incidentally noted bowel pathology and contraindications to CT colonography were also recorded. Results No perforation was identified either prospectively or in the course of our retrospective review. However, 15 patients (3.8%) were found to have potential contraindications to CT colonography, including: acute diverticulitis, acute colitis, and poor bowel preparation. Overall, the bowel preparation was felt to be adequate (≥ 3) in 86% percent of patients. Two patients (0.5%) identified prospectively had their CT colonography postponed due to poor bowel preparation.