I've only seen a handful of loopograms in my career, but every time I encounter the procedure, I am often in the company of Technologists and Radiologists who have never heard of or seen one. So what is a loopogram?
Whenever there is a large amount of bladder removed, usually due to Ca, the ureters can be connected to a loop of small bowel (ileum) which drains out of an ostomy (also called an ileal conduit) into an external drainage bag. The x-ray exam involves placing a small foley catheter into the conduit and injecting contrast retrograde to evaluate the bowel loop, ureters, and kidneys. The following supplies are needed:
Start by clamping the drainage bag, then removing it from the abdomen, making sure there are chux or towels underneath the patient's side of interest. You should have the contrast drawn into the 60cc syringe with foley connected and contrast flushed through the catheter. The Radiologist should apply the lubrication jelly, insert the foley and inject while the Technologist operates fluoroscopy and tends to patient needs. Here are some images during a loopogram:
Initial injection of about 10mL with the foley balloon inflated.
About 15mL - beginning to see retrograde filling of ureters to renal pelvis on patient's right side.
Contrast seen in patient's left renal pelvis after 20mL injected.
Post-drainage KUB with drainage bag reconnected - showing retention of contrast.
A normal loopogram should not cause much pain, but possibly a little discomfort. If there is pain, it could indicate extravasation of contrast from a leak. Obliques are typically acquired (not shown here) and the contrast should drain on its own after the exam is completed.
Whenever there is a large amount of bladder removed, usually due to Ca, the ureters can be connected to a loop of small bowel (ileum) which drains out of an ostomy (also called an ileal conduit) into an external drainage bag. The x-ray exam involves placing a small foley catheter into the conduit and injecting contrast retrograde to evaluate the bowel loop, ureters, and kidneys. The following supplies are needed:
- Iodinated contrast (we use Omnipaque 240)
- Small foley catheter - 10-12 Fr.
- Lubrication jelly for the foley
- 60mL cath-tip syringe for the contrast
- 5 or 10mL syringe for the foley balloon (if needed)
- gauze
- chux or towels to catch any drainage
- new drainage bag if needed
- gloves
- hemostat
Start by clamping the drainage bag, then removing it from the abdomen, making sure there are chux or towels underneath the patient's side of interest. You should have the contrast drawn into the 60cc syringe with foley connected and contrast flushed through the catheter. The Radiologist should apply the lubrication jelly, insert the foley and inject while the Technologist operates fluoroscopy and tends to patient needs. Here are some images during a loopogram:
Initial injection of about 10mL with the foley balloon inflated.
About 15mL - beginning to see retrograde filling of ureters to renal pelvis on patient's right side.
Contrast seen in patient's left renal pelvis after 20mL injected.
Post-drainage KUB with drainage bag reconnected - showing retention of contrast.
A normal loopogram should not cause much pain, but possibly a little discomfort. If there is pain, it could indicate extravasation of contrast from a leak. Obliques are typically acquired (not shown here) and the contrast should drain on its own after the exam is completed.
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