A method of double-contrast roentgen examination of the small intestine.

Abstract

Advances in accuracy of diagnosis of lesions in the esophagus, stomach, duodenal bulb, and colon have far surpassed achievements in demonstration of organic lesions of the jejunum and ileum. Though great strides have been made by Mackie (25), Snell and Camp (39), Golden (19), Pendergrass and Comroe (31) and others in the demonstration of functional changes in the bowel, adequate examination of the small intestine and satisfactory delineation and demonstration of its lesions remain a challenge to the radiologist. There are three principal reasons for lack of progress in roentgen diagnosis of small bowel lesions: (1) the time-consuming nature of the examination; (2) difficulty in interpretation of minor changes in the bowel; (3) the extremely low incidence of organic disease in this part of the digestive tract, so that the examiner has little to show, in the way of positive diagnoses, for the effort expended in many examinations. It is the purpose of this paper to review the various methods of examination of the small intestine, furnishing a background for the development of the double-contrast technic used in selected cases in the University Hospitals (Minneapolis). Current Methods of Examination of the Small Bowel and Review of the Literature Oral Administration of Barium: The method most frequently employed in the roentgen examination of the small intestine is the so-called “motor meal,” more recently designated by Golden as “the intestinal study” (19). It is based on the administration of barium sulfate by mouth in varying quantities and concentration. Morse and Cole (29) described a standard technic for the procedure in 1927 and Golden subsequently modified this, administering a mixture of 120 gm. of barium sulfate suspended in 4 or 5 ounces of physiological saline solution. He recommended that films be made at half-hour intervals for a period of five to six hours, with fluoroscopy two or three times during this interval and spot films to demonstrate areas of suspected anatomical variations. Weber and Kirklin (43, 44, 45) use 8 ounces of a mixture of equal parts (by volume) of water and barium sulfate. The patient is examined roentgenoscopically at fifteen-minute intervals, spot films being obtained as indicated. When the stomach is almost empty, a palatable meal is given for the purpose of stimulating peristalsis and accelerating the passage of the head of the meal into the terminal ileum and colon. The usual delay in filling of the terminal ileum is thus avoided. Åkerlund (6) uses a thinner mixture, consisting of three parts of barium sulfate to four parts of water and stresses especially the fluoroscopic examination. In 1937 Pansdorf (30) advocated fractional filling of the small intestine by administering the barium mixture in four 1-ounce doses at fifteen-minute intervals. Hodges (23), aware of the time-consuming nature of small bowel examination, adopts a practical approach for screening of patients.