A 76-year-old male presented with hematemesis, epistaxis, pedal edema, and generalized weakness for one day and also with a history of peptic ulcer disease, coronary artery disease, and chronic alcohol use presented with hematemesis, hypotension, and renal impairment. A CT abdominal angiogram was performed to evaluate for vascular pathology. Laboratory findings indicated renal impairment with elevated urea (104 mg/dL) and creatinine (1.38 mg/dL). A CT abdominal angiogram revealed a partially thrombosed fusiform abdominal aortic aneurysm in the infrarenal segment measuring 4.7 cm in length and 3.7 × 3.7 cm in diameter, without evidence of rupture. Incidentally, hyperdense material was observed within the small bowel loops, despite no prior oral contrast administration, suggestive of vicarious excretion of intravenously administered contrast. Additional findings included bilateral pleural effusions, emphysematous lung changes, mild splenic infarcts, pancreatic atrophy, and diffuse atherosclerotic calcifications of the thoracoabdominal aorta and its branches. The presence of intestinal contrast excretion in this patient likely reflected impaired renal clearance secondary to renal dysfunction and systemic hypoperfusion. Vicarious excretion of contrast through the bowel is a rare but recognized compensatory mechanism in cases of renal insufficiency, shock, or circulatory compromise. This case underscores the significance of identifying vicarious excretion as an indirect radiologic indicator of renal dysfunction and systemic vascular compromise in elderly patients with atherosclerotic disease.
KEYWORDS: Vicarious excretion, Intravenous contrast, small bowel, Abdominal aortic aneurysm, Renal dysfunction, CT angiogram.
How to cite this article: Rithani KR, Sundaran S, Venkatraman I, Murugan G, Vicarious Excretion Of Iv Contrast Through The Small Bowel In A Ct Abdominal Angiogram Study. Int J Drug Deliv Technol. 2026;16(7s): 16-19; DOI: 10.25258/ijddt.16.7s.3
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