A diagnostic imaging test used to visualize the organs and structures in the abdomen. Repeated images with contrast media: a test used to visualize the gastrointestinal tract and assess its motility, often performed multiple times after the administration of contrast material.
Feasibility/Equipment: Technically feasible in the ICU, but commonly needs presence of radiology technician and resources for patient positioning (if sedated patient) and is associated with relevant radiation dose (many times higher than with chest x-ray).
Scoring information: none
Cost: medium costs related to equipment and personnel
Evidence: While the Royal College of Radiologists (RCR) issued multiple indications for abdominal radiographs in the emergency department [1], the American College of Radiology (ACR) has defined the utility of abdominal x-ray in adult patients with abdominal distension, bowel obstruction, paralytic ileus, foreign bodies, urinary calculi, pneumoperitoneum, post‐placement of the medical device and postoperative patients [2]. Assessment of GI motility in critically ill patients on plain x-ray is mainly limited to evaluation of bowel diameter, whereas repeated images after enteral application of contrast media allow some evaluation of passage. Evidence on usage and indications in critically ill patients is scarce.
Accuracy / measurement properties: Low-dose abdominal computed tomography (LDCT) allows obtainment of diagnosis more often as plain abdominal radiography (AR) (64% vs 22%). 51% vs. 26% of patients with AR vs. LDCT required further imaging [3]. Sensitivity for bowel obstruction has been reported 50% with AR and 75% with CT [4]. Bowel diameter can be measured on AR as confirmed in a recent study in critically ill patients measuring the effect of prucalopride on resolution of paralytic ileus [5].
References
- iRefer Guidelines, RCR Version 8.0.1, May 2017. Available from: https://www.irefer.org.uk/guidelines
- American College of Radiology . ACR‐SPR practice guideline for the performance of abdominal radiography. Available from: http://www.acr.org/-/media/ACR/Files/Practice-Parameters/radabd.pdf?la=en.
- Nguyen LK, Wong DD, Fatovich DM, Yeung JM, Persaud J, Wood CJ, de Vos D, Mendelson RM. Low-dose computed tomography versus plain abdominal radiography in the investigation of an acute abdomen. ANZ J Surg. 2012 Jan-Feb;82(1-2):36-41. doi: 10.1111/j.1445-2197.2010.05632.x.
- Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002 Oct;225(1):159-64. doi: 10.1148/radiol.2251011282
- Jandee S, Wetwittayakhlang P, Boonsri P. Efficacy of prucalopride in critically ill patients with paralytic ileus: A pilot randomized double-blind placebo-controlled trial. J Gastroenterol Hepatol. 2021 Feb;36(2):362-366. doi: 10.1111/jgh.15127.