Experimental study of mortality and morbidity of contrast media and standardized fecal dose in the peritoneal cavity

Background. The use of radiographic contrast media in the setting of possib le bowel ischemia and potential perforation is known to be associated with increased clinical risk. However there is a lack of controlled studies usin g a standard native: fecal load to define and compare the intrinsic mortali ty and morbidity among options of contrast media currently available to the radiologist. We have compared the mortality and gross and histopathologic morbidity of a standard intraperitoneal native fecal dose in the guinea pig , using barium, two iodinated media, saline and air. Materials and methods. The study was performed on adult Hartley guinea pigs . A standard native fecal solution with a colony count of 10(8) aerobes and 2 x 10(7) anaerobes was prepared, and the LD50 of intraperitoneal injectio n of the solution was determined. The standard solution at the LD50 dose wa s then used to compare the mortality and morbidity when commercial barium s ulfate (18% w/v), Conray 30 (iothalamate meglumine 30%), 1:1 dilution of Co nray 30 with sterile water, termed Conray "15" (iothalamate meglumine 15%), saline and air, were added to the intraperitoneal injection of the fecal s olution in five groups of 20 animals each. Mortality and acute (96 h) and c hronic (30 days) gross and histopathology were assessed and graded accordin g to a standard system and analyzed statistically. Results. Barium was significantly more deleterious than the dilute water-so luble iodinated media, saline and air. Mortality occurred within 24 h in th e barium group and within the initial 48 h in all groups as follows: barium 19/20 (95%); Conray 30 16/20 (80%); Conray "15" 7/20 (35%); saline 0; air 0. Acute gross and histopathology showed extensive grade 4 lesions in 19/19 barium animals; less severe lesions were present in a lesser percentage of the animals in the other four groups. Entirely chronic lesions were presen t only in the single surviving barium animal and were nonsignificant (<400 mu m) or absent in the other four groups. Conclusions. In our study, barium incurred the most significant deleterious short and long-term effects in the setting of fecal peritonitis. Dilute wa ter-soluble media offer a much greater margin of safety. Saline under sonog raphic guidance is less deleterious than any of the positive radiographic c ontrast media. However, in our study, air was the safest contrast medium in the setting of peritoneal soiling.