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The Use of Carbonated Beverages in Pediatric Excretory Urography

1955; Radiological Society of North America; Volume: 64; Issue: 1 Linguagem: Inglês

10.1148/64.1.66

1527-1315

John W. Hope, Francisco Campoy,

Hernia repair and management

Intravenous urography is an important diagnostic procedure in pediatric radiology, but there are two factors which make this examination a difficult problem: first, the large amount of gas and feces present in the gastrointestinal tract; second, the low specific gravity of the urine in infants, preventing concentration of the contrast medium and resulting in poor visualization of the pelvo-calyceal collecting system. Before the advent of the method to be described, we were often guilty either of calling for a repetition of the examination or concluding merely that it showed no gross abnormalities but that fine detail of the pelvo-calyceal collecting system could not be visualized. Pediatricians in the Philadelphia area often hesitated to order an intravenous urogram because so frequently no diagnosis could be made. Cathartics will usually clean out the fecal material from babies and children, but the amount of gas generally increases, thereby aggravating the problem. Propping the child in the upright position for several hours before the study is satisfactory in theory, but by the time the venipuncture has been performed and the contrast medium injected, the bowel is full of gas. Many clinics make no attempt at preparation of these young subjects but simply take preliminary films. If the abdomen is too full of confusing shadows, the patient returns on the following day for another preliminary film. Because of the high cost of hospitalization, it is imperative that diagnostic studies be performed as rapidly as possible. To keep a child several days in the hospital awaiting the disappearance of gas and feces is both uneconomical and undesirable. After a trial of the common methods of preparation for some six months, to no avail, we also came to the conclusion that it was better to omit all preparation. It was at this time that our attention was drawn to an article by Berg and Allen (1) describing the use of carbonated beverages as an aid in pediatric excretory urography. Though somewhat skeptical of this method, we decided to give it a trial. Because we personally liked Pepsi Cola, this was the first carbonated beverage to be employed. From the very first time this carbon dioxide-producing beverage was used, we were satisfied with the diagnostic quality of our intravenous urograms (Figs. 1 and 2). It has also been employed successfully for visualization of the spleen by contrast with the gas-distended stomach in cases in which a differential diagnosis between an abdominal mass and a low-lying spleen has to be made.