A 58-year-old man develops severe chest and neck pain two hours after upper gastrointestinal endoscopy. A perforation of the oesophagus is suspected. Which oral contrast agent should be used for the initial contrast swallow?

• A Barium sulphate suspension
• B Effervescent granules followed by barium
• C Low density barium diluted 1:1 with water
• D Water-soluble non-ionic iodinated contrast ✓

Explanation

When perforation is suspected, the initial study must use a water-soluble non-ionic iodinated agent such as iohexol. Extravasated barium provokes an intense inflammatory reaction and mediastinitis, so it is avoided first line. Only if the water-soluble swallow is negative but clinical suspicion persists is dilute barium used next, because it is more radiopaque and detects subtle leaks. Effervescent agents distend the oesophagus and would worsen extravasation through a leak.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.