Small Intestine—Inflammatory Lesions and Accompanying Reactions

Abstract

THE subject, “Inflammatory Lesions and Accompanying Reactions,” is so extensive that we thought it best to approach the discussion under four main divisions. These are apt to overlap, and, under any circumstances, should be considered merely arbitrary divisions. Your attention will be directed to these similarities as they occur. The four main divisions are as follows: (A) Normal; (B) Interference with motor phenomena; (C) Products of inflammation; (D) Reactions in certain systemic diseases. As the radiologic technic employed in making gastro-intestinal examinations varies so widely in the hands of different physicians, it is necessary to present the normal, secured under the same technical conditions as the abnormal, in order to have an adequate control. Six ounces of a mixture of barium and water of a consistency comparable to thick cream is given on a fasting stomach. We insist upon overnight fasting as it is essential for the small intestine to be absolutely empty. The films are made at intervals which vary according to the type of case under consideration. Two very important technical factors are rapid screens and a maximum exposure time of a quarter of a second. A maximum exposure of a tenth of a second is preferable as the minor motor phenomena are so rapid that speed is demanded to secure detail. The normal rate of progress of the barium through the small intestine has a wide individual physiologic variation. Usually the head of the barium column enters the cecum within from two to four hours. The mucosal pattern and the general characteristics of the two main divisions of the mesenteric small intestine are distinctive and fairly consistent. The division of the small intestine radiologically into six distinct groups has been described before this Society and appeared in 1927 in its Journal.2 As we may later refer to an area being in a certain group, it is wise to review this division. A schematic drawing to illustrate this division shows groups one, two, three, four, five, and six, and a slide demonstrating these groupings in a patient.3 Group one, duodenum; group two, consists of coils in the upper left quadrant; group three, located in the lower left quadrant. The directions of the coils in these groups is transverse, that is, across the abdomen. Group four is located in the mid-line and the coils, finger-like in appearance, with the lumen running in a vertical direction; group five is located in the right lumbar region; group six is the terminal group of coils in the lower right quadrant; in the fourth and fifth groups you will note that the direction of the lumen is chiefly vertical, although it may be a mixture of both transverse and vertical. In observing these groups, the barium passed uninterruptedly through the various coils into the cecum. There was no delay in any particular group, and the characteristics of the various segments correspond to the normal.