Iopamidol in the diagnosis of suspected upper gastro-intestinal perforation

Forty patients, mainly post-operative, were examined for suspected leakage from the oesophagus and/or stomach using iopamidol. Oesophageal leaks were demonstrated in seven patients, tracheo-oesophageal fistulae in two and an unsuspected gastro-jejunostomy intusussception in one. Only two cases were regarded as technically unsatisfactory due to poor coating. Normal examinations were found in 28 (70%) patients. This was confirmed by the subsequent clinical course. Aspiration into the bronchial tree occurred in five (12.5%) patients without ill-effects. Furthermore no adverse side effects as a result of the administration of iopamidol were recorded. It is concluded that a non-ionic medium such as iopamidol is the agent of choice in the detection of oesophageal and gastric perforation, particularly in post-operative patients where there is an increased risk of aspiration.