Upper GI contrast study
Oesophagus, stomach and duodenum to the duodenojejunal flexure
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Bilious vomiting in an infant — suspected malrotation with or without volvulus.
- Suspected gastric outlet obstruction or anastomotic complication.
Technique
- The position of the duodenojejunal flexure is the point of the study: it should lie to the left of the vertebral pedicle at the level of the duodenal bulb.
Where it goes wrong
- Bilious vomiting in a neonate is a surgical emergency — malrotation with volvulus can infarct the entire midgut within hours, so this study must not be scheduled routinely.
Clinical questions that reach this study
Contrast
Acquisition
Phases
Each phase is authored once and shared across every protocol that uses it, so the physiology below is the same wherever you meet it.
- Positive oral contrastIngested in divided volumes beginning roughly 60 min before scanning (commonly split doses at about 60, 45 and 15 min), so that the bolus front reaches the distal small bowel. Confirm locally.
A dense intraluminal agent labels bowel as bowel. The transferable principle is that the hardest structure to exclude on abdominal CT is unopacified bowel masquerading as something else — a collection, a mass, a leak, an abscess — and that the problem is worst exactly where mesenteric fat planes are thinnest, in the cachectic and the paediatric patient. Positive agents also demonstrate luminal continuity, so extraluminal contrast becomes direct evidence of perforation, leak or fistula. The trade-offs are symmetrical and important: the same density obscures mucosal enhancement, defeats bowel-wall assessment, degrades CT angiographic and three-dimensional reconstructions, and creates streak artefact, which is why several high-volume indications deliberately use a neutral agent instead.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- Child-sized technique and contrast dose· radiographer at scan
- Pregnancy status before an ionising exposure· radiographer at scan