Mesenteric Diatrizoate Pooling Mimicking an Anastomotic Leak in Multi-Organ Dysfunction

Area of Science:

• Gastroenterology
• Radiology
• Surgical Critical Care

Background:

• Patients with multi-organ dysfunction after severe physiological insult, like cardiac arrest, present diagnostic challenges.
• Enteral contrast agents can be absorbed and retained in unusual locations.
• Accurate interpretation of imaging is crucial for patient management.

Purpose of the Study:

• To describe a specific imaging artifact caused by enteral diatrizoate absorption.
• To differentiate this artifact from actual anastomotic leaks on CT scans.
• To guide clinical decision-making in critically ill patients.

Main Methods:

• Review of CT imaging findings in patients with multi-organ dysfunction.
• Correlation of imaging findings with clinical presentation and outcomes.
• Analysis of contrast agent behavior within the mesenteric tissue.

Main Results:

• Enteral diatrizoate was observed to be transmurally absorbed and sequestered within a contused mesentery.
• This phenomenon mimicked the appearance of an active anastomotic leak on CT scans.
• Patients remained clinically stable with no significant fluid collections despite the apparent leak.

Conclusions:

• Mesenteric retention of enteral diatrizoate is a potential imaging pitfall.
• Distinguishing this artifact from anastomotic leaks requires careful clinical correlation.
• Clinical stability and absence of fluid collections are critical factors in avoiding unnecessary re-interventions.