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March 15, 1965

A Rapid Bedside Test for Intestinal Perforation

Author Affiliations

Students, University of Missouri School of Medicine, Columbia (Mr. McCraw and Mr. McLeod), University of Pennsylvania School of Medicine, Philadelphia (Mr. McDonald); and Professor of Surgery, University of Missouri School of Medicine, Columbia (Dr. Stephenson).

JAMA. 1965;191(11):939-941. doi:10.1001/jama.1965.03080110063023

SPONTANEOUS and traumatic perforations of the gastrointestinal tract, in spite of widespread use of antibiotics, are still associated with high morbidity and considerable mortality. The crux of adequate management frequently centers on early diagnosis. Unfortunately, the onset of peritonitis from perforation may be insidious and may escape early detection. Such generally reliable signs as free air under the diaphragm and paralytic ileus may be absent or equivocal. The purpose of this report is to describe acid precipitation of diatrizoate in urine as an additional diagnostic measure which has shown promise both in the laboratory and in limited clinical application.

Methods and Results  The use of orally administered water-soluble iodinated contrast media, particularly meglumine diatrizoate (Gastrografin) and sodium diatrizoate (Hypaque sodium) has become widely accepted in gastrointestinal radiography. Meglumine diatrizoate and sodium diatrizoate, used interchangeably in this study, are essentially unabsorbed by the gut lining (0.4% to 1.20% of the ingested