Early roentgen manifestations of mild ulcerative colitis and proctitis.

Abstract

Proctocolitis has been defined as an inflammatory condition of the rectal mucosa in which there are: a clear upper limit beyond which the mucosa is normal, failure to identify a specific cause for the inflammation, and a normal colon on x-ray examination (12). The concept that roentgen examination of the colon is of little assistance in the diagnosis of early changes in ulcerative colitis is well established. In a series reported by Ricketts, Kirsner, and Palmer (15), for example, the barium-enema examination was reported as normal in 60 of 150 patients. The purpose of this report is to indicate that careful study of an apparently normal, routine colon examination in most cases would reveal minor but definite variations from normal, indicative of inflammatory changes in the mucosa. Selection of Patients The method of selection of cases for this investigation has been described in detail (18) and will be mentioned only briefly. The records of 1,181 patients with unequivocal symptoms and proctoscopic evidence of ulcerative colitis were reviewed. The cases in which colon examinations were reported as either normal or with involvement of the rectosigmoid region only were selected for further study, the films of 292 patients being available for such a review. On the basis of combined roentgen and proctoscopic findings, 45 of these patients were considered to have ulcerative proctitis. This report is based on the findings, radiographic and proctoscopic, in these 45 patients. Technic of Colon Examination At the University of Chicago Medica Center, the patient is prepared for roentgen examination of the colon in the following manner. On the day prior to examination, 60 cc of castor oil is administered at noon and no solid food is permitted subsequently. The patient also is instructed to take nothing by mouth after midnight on the evening before the examination. Thorough cleansing of the bowel is essential, and in our experience the administration of castor oil to patients with mild ulcerative colitis and ulcerative proctitis has not produced an exacerbation of the disease. Most patients are examined with a conventional filling and evacuation technic. Prior to 1958, lateral films of the rectum were not obtained routinely. Since that time, this projection has been considered an essential part of the examination and always has been included. Films made on the filming fluoroscope of the sigmoid, splenic and hepatic flexures, and the ileocecal region are also obtained. After this, a prone film of the filled colon and, later, a post-evacuation film are taken. Occasionally, a double-contrast examination is performed, usually following the routine examination. The stock barium solution contains barium sulfate 46 per cent by weight, sodium earboxymethylcellulose 0.75 per cent, methylparaben 0.05 per cent as preservative, and one part per million anti-foam. Tannic acid has never been used.