Intestinal vessels were first made radiopaque by translumbar aortography. The contrast media employed in the early days were sodium iodide and iodopyracet (Diodrast). Necrosis and perforation of the small intestine occasionally attended their use. This was thought to be due either to the inherent toxicity of the medium or to its excess concentration (9). It was hoped that sodium acetrizoate (Urokon) would be less dangerous, but intestinal necrosis and deaths were reported following the injection of 70 per cent Urokon into the mesenteric arteries. When sodium diprotrizoate (Miokon), sodium diatrizoate (Hypaque), and methylglucamine diatrizoate (Renografin) became available, they were believed to be safer than sodium iodide, Diodrast, or Urokon. Lloyd (6) in comparative studies showed Hypaque to be less toxic than Miokon, and this was confirmed by Stokes (13) and Chaplin and Carlsson (1). Fischer and Eckstein (3) found fewer systemic effects with Renografin in cerebral angiography than with either Urokon or Hypaque. Hoppe (4) injected 50 per cent Hypaque into the marginal ear vein of rabbits with no tissue damage. In spite of the reports of intestinal necrosis and perforation after the intraarterial injection of contrast media, few detailed studies of their effects on the small bowel have been made. Various investigators have used the survival of patients or experimental animals as proof of the safety of such injections (10–12). Absence of catastrophic symptoms and survival, however, indicate only that complete necrosis with perforation of the intestine did not occur. Since mesenteric arteriography shows promise as a diagnostic aid (7, 8, 11, 12), we undertook a study of the effects of Miokon, Hypaque, and Renografin on the small intestine.2 Method Full-grown, healthy male mongrel dogs weighing about 30 pounds were used. These animals were anesthetized with sodium pentobarbital, celiotomy was performed, and a loop of distal ileum was selected for injection. In many dogs more than one loop was used. The artery to the loop was then dissected free and cannulated with a 21-gauge scalp-vein needle. Great care was taken not to damage the adjacent vein. The selected contrast medium in various concentrations and dosages was injected rapidly by hand into the artery, and roentgenograms were obtained at the completion of the injection and three minutes later. When multiple loops were injected in the same dog, at least one interval artery and vein were left intact. Contraction of the loop of intestine during and after injection was observed and graded as 0 through 4+. Numerous control loops were either injected with 20 ml. of normal saline or the artery was ligated and nothing injected. Autopsies were done on the dogs that died. In all that survived, the injected loops were resected three weeks after injection. All segments were studied grossly and microscopically.
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Open Access
Jan 1, 1984
Kazuo Awai + 4
