Bile Backing Up Into a Crohn's Patient's Stomach May Have Turned His Scan Drink Into Bright Balls

What To Know

Doctors reported a 25-year-old with Crohn's disease, bile reflux, and a duodenal stricture who drank a 2.5% mannitol solution before CT; the scan showed several bright, round lesions in the stomach. The team did a bench experiment using mannitol with artificial gastric juice and bile and observed a precipitate, which they propose explains the CT appearance.

They did not remove or chemically analyze the actual stomach material because repeat endoscopy was judged unnecessary, so the precipitate explanation is plausible but not definitively proven.

The authors recommend radiologists consider this cause — especially in patients with recent endoscopy, bile reflux, or duodenal narrowing — to avoid misinterpreting such findings as retained pills or active bleeding.

Practical takeaway: If you have a recent endoscopy, known bile reflux, or duodenal narrowing and are scheduled for CT with oral contrast, tell the imaging team about recent procedures and exactly what you swallowed; clinicians and radiologists should include contrast precipitate in the differential when bright gastric foci are seen.