Renal Excretion of Gastrografin after Oral Administration: Clinical Significance in Gastric Resection Patients

Sohn, Kyung Myung; Kwon, Oh Han; Lee, Sung Yong; Joo, Jong Kwan; Lee, Jae Hee; Kim, Ki Jun; Lee, Jae Mun

Abstract

PURPOSE: To evaluate the clinical significance of renal excretion of oral Gastrografin in gastric resectionpatients. MATERIAL AND METHOD: Seven days affter gastric resection, eight normal volunteers and 30 patientsunderwent abdominal and CT scanning before and 1-1.5 his after oral administiration of Gastrografin. Theattenuation coefficients of the bladder were measured and the maximal attenuation difference between pre-andpost-gastrografin administration was calculated.
RESULTS
In the control group, there was no abnormal renalexcretion of oral Gastrografin, though in 83 % of patients(25 of 30), this was demonstrated as focal increase inthe density (> or = 20 HU) of the bladder and/or collecting system, or ureteral opacification. Mean maximal densitydifference was 84.4+/-82.9HU in the patient group (n=24), with renal excretion of enteral Gastrografin and,3.5+/-4.4 HU in the control group (n=7), with statistical significance (Student's t-test, p<0.01). No patientshowed either radiological or clinical evidence of direct leakage from the suture site. Patients who underwenttotal gastrectomy showed a higher maximal density difference than those in whom gastrectomy was subtotal.
CONCLUSION
Unless direct leakage is visvalized on fluoroscopy or spot films, renal excretion of oralGastrografin should not be regarded as a sign of anastomotic leakage. Situations other than leakage, e. g.increased mucosal permeability or absorption, or increased bowel transit time in postoperative duration, should beconsidered as possible causes.