Systemic absorption of contrast agent during endoscopic retrograde cholangiopancreatography

Abstract

The following case illustrates clearly that absorption of a contrast agent Reno-M-60® (Meglumine diatrizoate), indeed, can occur. CASE REPORT A 42 year old woman was referred for the evaluation of recurrent bouts of midepigastric pain. Cholecys­ tectomy had been performed 4 years previously for cholecys­ titis and cholelithiasis. The serum and urine amylase, as well as serum lipase determinations, were normal. Intravenous cholangiography performed during the present hospitaliza­ tion revealed a common bile duct 12 mm in diameter with relatively poor distal visualization but suggestive of a distal stricture or small stone. In this context, ERCP was performed. After the pharynx was anesthetized with Cetacaine® (Ben­ zocaine) topical anesthetic, the patient was sedated with 10 mg of intravenous Valium ® (Diazepam). The Olympus )FB side-viewing duodenoscope was then passed into the duodenum. Glucagon, 1 mg intravenously, established duodenal paralysis. The ampulla was identified, and free cannulation was accomplished. Reno-M-60® was injected by hand pressure, and opacification of the main pancreatic duct was obtained. With slow withdrawal and continuous gentle injection, opacification of the common bile duct was accom­ plished. Both ductal systems were interpreted as being nor­ mal. During the injection the patient experienced mild, midepigastric discomfort while an intense pancreatic acinari­