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What is Safest contrast in esophageal perforation and explain in detail?
Ans. (a) IohexolRef: Shackelford, 7th Edition, Page 86Contrasts to detect leak and perforation:Two contrasts are commonly used to detect perforation* Barium* Water soluble contrasts:# Low osmolar: Iohexol, Metrizamide# High Osmolar: Diatrazoate (Gastrograffin)* High osmolar Gastrograffin (Diatrozoate meglumine): has more chances of pulmonary edema than low osmolar contrasts like Iohexol (Omnipaque) and metrizamide (Amnipaque).In conclusion:* Best to diagnose perforations - High density Barium* Safest in usage: Low osmolar Water soluble contrasts like Iohexol and Metrizamide