THE 90 MINUTE FOLLOW THROUGH: A SIMPLE TECHNIQUE FOR EXAMINATION OF THE SMALL INTESTINE.

Abstract

Radiological examination of the small intestine in children presents problems not commonly encountered in adult patients. When ordinary techniques are employed flocculation and segmentation may occur in children with malabsorption syndromes and also quite commonly in normal children. (The view that these phenomena give a useful estimate of malabsorption has been quite outmoded by the standard biochemical techniques used to assess this aspect of small intestinal function.) Flocculation and segmentation prevent satisfactory definition of the wall of the small intestine. Detail may be adequate only in the jejunum even when employing a contrast medium such as Raybar, specifically recommended for examination of the small intestine. The ordinary follow-through examination of the small intestine is usually a time-consuming procedure. Harden (1960) and more recently Trickey, Halls and Hodson (1963) have advocated the use of the small bowel enema. However, children do not tolerate intubation well, an extensive small bowel abnormality may be obscured by the slight distension of the bowel which this technique produces, and the potential danger of fluid imbalance in children with extensive disease of the gut is always to be feared. Other radiologists (Margulis and Mandelstam, 1961) have advocated the use of neostigmine to improve the quality of the examination of the small intestine, but unnecessary injections are undesirable. In this paper a simple technique for examination of the small intestine is described. It has given satisfactory results in over 100 children of one year upwards and flocculation and segmentation have very rarely been troublesome.