When Diagnosing Appendicitis, Skip the Enteral Contrast

Summary and Comment |
August 8, 2014

When Diagnosing Appendicitis, Skip the Enteral Contrast

  1. Cheryl Lynn Horton, MD

Diagnostic efficacy of CT imaging with intravenous contrast was equivalent with and without enteral contrast in patients with suspected appendicitis.

  1. Cheryl Lynn Horton, MD

To determine if the addition of enteral contrast improves sensitivity of computed tomography (CT) imaging with intravenous (IV) contrast for diagnosing acute appendicitis, researchers evaluated medical records for 9047 patients who underwent nonelective appendectomies at 56 hospitals in Washington State during 2010 and 2011. Most patients (89%) received CT imaging, and, of these, 54% received IV contrast alone and 29% received IV plus enteral contrast (oral, rectal, or both).

Concordance between final radiology and pathology reports was 90.0% for patients receiving IV plus enteral contrast and 90.4% for those receiving only IV contrast; concordance was significantly lower for those who did not receive contrast (85.7%). Predictors of concordant CT imaging were older age and increasing weight; predictors of discordant CT imaging were lack of contrast and presence of three or more comorbid conditions. Mean time from emergency department (ED) admission to operation initiation was 48 minutes longer for patients receiving enteral contrast than for those receiving IV contrast only.


Many medical centers are moving toward eliminating enteral contrast for most abdominal CT imaging, as it adds no benefit and lengthens ED stay. When evaluating young and thin patients with suspected appendicitis, ultrasound imaging may be a reasonable place to start. For patients requiring CT imaging, IV contrast alone is sufficient, as enteral contrast offers no diagnostic benefit and should be avoided.

Editor Disclosures at Time of Publication

  • Disclosures for Cheryl Lynn Horton, MD at time of publication Nothing to disclose


Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.