Barium Enema Films Research Articles

The outcome of single-stage management of Hirschsprung's disease at a tertiary care center

Background: Hirschsprung's disease (HD) was initially treated as a multistage procedure. Subsequently, it has been recognized that surgery can be done as a single-stage at an early age as this approach is safe, cost-effective, and avoids the morbidity associated with stomas. We study the effectiveness and safety of single-stage management of HD using Langer's or Georgeson's techniques, to analyze the outcome of surgery, and its comparison with other similar studies. Patients and Method: The study was retrospectively carried out in our institution from October 2016 to September 2019. They were operated in a single-stage either by Langer's procedure or by laparoscopy-assisted Georgeson's procedure. Inclusion criteria were clinically diagnosed cases of HD with an obvious transition zone. Patients without a funnel (on barium enema films) were excluded. Results were analyzed using IBM SPSS statistics 20.00 software. Result: The present series included 28 patients. The mean age of the patients was 16.24 months. Mean intra operative blood loss for Langer's series was 30 ml and Georgeson's series was 20 ml. The mean operative time for Georgeson's procedure was 150 min and for Langer's, it was 90 min. Postoperative enterocolitis 3 (10.7%), persistent constipation 2 (7.5%), and perianal excoriation 9 (32.14%) were some of the important complications noted. Conclusion: Single-stage surgery for HD is safe and avoids the need for multiple operations including stoma and its related complications.

Wessex regional radiology audit: Barium enema in colo-rectal carcinoma

In the first Wessex regional radiology audit, a retrospective comparison of pathology and radiology reports was made to determine rates of demonstration and reporting of colo-rectal carcinoma on barium enema. Barium enema films were analysed by peer review in cases of discrepancy. The standard set was 100% demonstration and 100% diagnosis of colo-rectal carcinoma on a barium enema undertaken in the 12 months preceding histological diagnosis. The carcinoma demonstration rate was 97% and carcinoma reporting rate 85%. Of 1351 patients with carcinoma, 557 had a barium enema in the preceding 12 months. Four hundred and seventy-one enema reports satisfactorily recorded the malignant lesion (85%). The reasons for non-reporting of a carcinoma were failure to demonstrate the lesion (18 cases, 3%), failure to perceive a demonstrated lesion (23 cases, 4%) and failure to analyse a perceived lesion (45 cases, 8%). Any improvement in demonstration cannot be estimated, but 94% of carcinomas should be reported when improved reporting techniques are instituted and the audit loop is closed.

Site distribution of colonic adenomas and carcinomas in relation to colonic flexures.

To minimize the chance of overlooking colonic tumours, 'short segments' of the colon were defined and examined on barium enema films in relation to the distribution of colonic tumours. Films of 299 histologically proven adenomas and carcinomas from 265 consecutive patients were used. No significant differences in distribution were noted between the adenomas and carcinomas. The distance of tumours from distal minor flexures was within seven centimetres in 80% of lesions in the transverse colon, five centimetres in 80% of lesions in the descending colon, and four and six centimetres respectively for 80 and 95% of sigmoid colon lesions. In the cecum plus ascending colon 75% of the lesions were located within seven centimetres from the cecal pole.

A CASE OF CROHN'S DISEASE OF THE COLON IN AN ELDERLY WOMAN

We reported a case of Crohn's disease of the colon which was rare to occur in elderly patient.A-71-year-old woman was admitted to the hospital because of left lower abdominal pain and watery diarrhea.We diagnosed her disease as Crohn's colitis distributed from the transverse colon to the sigmoid colon by barium enema examination colonoscopy with biospy. After admission, we started a conservative therapy by salazopyrin and IVH, but it was nessesary to stop the drug because of its allergy. Instead, we started adrenal criticosteroid and flazyl therapy. But there was no improvement of the disease after the therapy of two months duration presenting bloody stool, and left hemicolorectomy was mandatory. The serosa of the resected colon was normal and no fistula was found, and the mucosa showed only the cobblestone appearance. After operation, the symptoms disappeard without any lesions on barium enema films, and she was discharged from hospital. This patient could be cared by surgical management, not persisting in conservative therapy, because of exacerbation of melena and depleted compensation ability.

ＣＴによる直腸癌の深達度診断補遺

Preoperative pelvic computed tomographic (CT) images were analyzed in 50 patients with rectal carcinoma to evaluate the depth of mural invasion. Firstly the rectum was inflated with air. Secondly cross-sectional CT images of the rectal carcinoma were taken, in all cases referring to lateral scout view films and barium enema films. The circle rate of the tumor was determined in the cross-sectional image. Perirectal changes on CT were evaluated where there were spiculated and nodular appearances. The circle rate correlated with the extent of mural invasion. In cases within 1/3 circle in the circle rate and without perirectal nodular appearance, more than 90% of the tumors were limited to the muscularis propria of the rectal wall. These findings were very useful for assessing suitable surgical treatment.

Poas abscess demonstrated by CT as the first evidence of carcinoma of the colon

We report a case of right psoas abscess resulting from a carcinoma of the ascending colon. Abdominal CT examination suggested a preoperative diagnosis of neoplasm of the colon, which was confirmed on barium enema films and at surgical operation.

Towards a radiologic definition of idiopathic megacolon.

Measurements of bowel width and rectal area were used to define normal limits of size in 50 double-contrast barium enema films. Two types of patient with constipation were defined by comparison with these results. In 18 women with prolonged whole-gut transit time, the measurements were within the normal range. Of 11 men and 9 women with a previous radiologic diagnosis of idiopathic megacolon, all had an enlarged rectum and the abnormal width extended proximally to involve the colon for a variable distance. A width of 6.5 cm at the pelvic brim provides a convenient and discriminating separation of normal from abnormal.

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

Colonoscopy: An essential monitoring technique after resection of colorectal cancer

A pilot study was undertaken to determine the usefulness of colonoscopy in the postoperative follow-up of patients with colorectal cancer. Of 56 patients, 9 (17 percent) had positive intraluminal examinations, including one recurrent cancer and three large polyps (greater than 1 cm) despite normal barium enema films. Twenty percent had negative colonoscopic findings which ruled out suspicious lesions on roentgenograms. More than one third had alterations in therapy as a result of colonoscopic examination. Colonoscopy is a useful and fruitful diagnostic aid in the follow-up of colon cancer. It should be used early in the postoperative period and added at rational intervals in long-term surveillance. It appears to complement other accepted methods of detecting recurrence.

Colonoscopic Diagnosis and Management of Rectal Bleeding

The use of the colonoscope to evaluate the cause of rectal bleeding in a series of 2200 patients has been reviewed. The most common cause of bleeding in this series was found to be neoplastic polyps, which were present in 723 patients (32 per cent). Colonic carcinoma was detected as the source of the bleeding in 425 cases (19 per cent). Although a large number of barium enema films were false negatives, the patients reviewed are a highly select group. It is still believed that barium enema studies and colonoscopy are complementary rather than competitive procedures. Their continued combined use greatly enhances diagnostic accuracy. Various other causes of colonic bleeding, including inflammatory bowel disease, arteriovenous malformations, endometriosis, ovarian carcinoma, ischemic colitis, and radiation colitis, have been discussed and their endoscopic appearance described. Of particular significance is the coexistence of internal hemorrhoids or diverticular disease and neoplastic colonic lesions. Barium enema films and sigmoidoscopy have been frequently described as the twin pillars of diagnosis in the detection of colonic pathology. Colonoscopy, as the third pillar of diagnosis, should be an integral part of the evaluation of patients with rectal bleeding.

Colonoscopic polypectomy in children.

Five children presenting with chronic and intermittent rectal bleeding were diagnosed as having colorectal polyps by fibreoptic colonoscopy performed under sedation. Three of the children had had barium-enema films reported on as normal. Eight polyps were seen, of which six were proximal to the sigmoid colon. All were removed endoscopically (one by proctoscopy, one by snare-intussusception) without complication. Colonoscopic polypectomy is a safe and efficient procedure in children, and colonoscopy may be regarded as first-line management in those with rectal bleeding.

2. Two Gases of Lipoma of the Colon Accompanied with Intussusception

Lipoma of the colon is a relatively rare disease, reported only 52 cases in Japan.In this paper two cases of lipoma of the colon accompanied with intussusception are reported. Intussusception in adults is rare and, in contrast to the disease occurring in infants, is mostly based upon a prominent organic lesion (e. g. lipoma).As regards lipoma of the colon, the frequency of complication with intussusception is so high as can be estimated 49 per cent in the Japanese literature.Case 1. A 54-year-old woman was admitted to our hospital with chief complaints of abdominal pain, etc. On barium enema films intussusception of the ascending colon and a large tumor shadow in the cecum were demonstrated. Right hernicolectomy was done. The resected specimen showed a polypoid tumor measuring 5.0×3.5×3.5 cm in the cecum. The histological diagnosis was lipoma.Case 2. A 68-year-old woman was sent to our hospital with the complaints of abdo-minal pain, etc. Barium enema showed a global submucosal tumor in the descending colon, accompanied with intussusception. Left colectomy was porformed. The resected specimen showed a submucosal tumor measuring 1.7×1.6×1.0 cm of which histological diagnosis was lipoma.

Ischemic dilatation of the colon.

Ischemic colitis may present as dilatation of the colon, often seen in acute ulcerative colitis. Clinical history and radiographic findings usually suffice to differentiate these two lesions. Prompt surgical treatment is indicated for ischemic dilatation. Two cases are presented to show that ischemic colitis may progress to transmural gangrene, without striking clinical change. Repeated barium enema and plain abdominal films are required for the management of patients with ischemic colitis, who do not promptly recover. The progression from thumb printing to ulcerative and pseudopolypoid changes on barium enema, or the development of dilatation in a segment of ischemic colon, indicates necrosis and requires immediate surgical treatment.

Area of colon visualized through the sigmoidoscope.

The diagnosis of diseases of the colon is largely dependent on the findings revealed by roentgenographic examination of the barium-filled colon and by sigmoidoscopy. The barium enema can usually be relied upon to visualize the colon down to the region of the rectosigmoid; however, the colon is notorious for its tendency to have redundant, overlapping loops in the region of the sigmoid, frequently making it difficult to examine this area adequately. Since the high incidence of lesions in the vicinity of the rectosigmoid is well known, the cliniċian often feels uneasy about accepting a normal roentgenogram report when the patient has symptoms suggestive of disease in this area. With the 10 in. (25 cm.) sigmoidoscope, the rectum and a portion of the distal sigmoid can usually be visualized. The knowledge of just how much of the sigmoid is seen through the sigmoidoscope when one is evaluating the barium enema films

Clinical and Roentgen Aspects of Internal Biliary Fistulas

Internal biliary fistulas have been reported mainly on the basis of findings at surgery or necropsy. In an extensive review of the literature the incidence of such fistulas (in the larger groups reported) at the time of routine biliary surgery was found to be as follows: While many unusual fistulas have been described, the main types are cholecystoduodenal, cholecystocolic, and choledochoduodenal. Of 819 cases reported with surgical findings, only 9 per cent were in locations other than one of these three sites (Table II). Such a summary of the literature yields a total number of cases large enough for accurate evaluation of the anatomic and pathologic factors involved. Etiologic Factors The reported frequency of the various etiologic factors of internal biliary fistula has been fairly consistent. Gallbladder calculi, as the primary cause, are listed in 85 to 90 per cent of all surgical series; these include principally the cholecystic fistulas. Garland and Brown (8) point out that “if a gallstone can be detected or there is a reliable history of its presence, a spontaneous internal biliary fistula is apt to be cholecystoduodenal.” Tracey and McKell (4) state that, when stones are not found in a cholecystic internal fistula, one can suspect that they have been passed without the patient's knowledge. In the series of such cases reported from the Mayo Clinic (1), the approximate 3:1 ratio of females to males is in accord with the known sex incidence of cholelithiasis in relation to the development of fistulas. This association is well demonstrated by the following cases of cholecystoduodenal fistula (Cases I–III). Case I (C. H.): One week prior to emergency admission to the hospital, an 85-year-old white woman began to experience progressive flatus and epigastric distention. Two days preceding hospitalization, there was increasing upper abdominal distention, with associated vomiting. Examination showed the upper abdomen to be distended and revealed visible peristalsis. A clinical diagnosis of obstruction of the small intestine was made. The white blood cell count was 20,000, with 95 per cent polymorphonuclears. X-Ray Studies: Barium enema films were not remarkable except for atypical gas shadows in the right upper quadrant, apparently of gallbladder origin (Fig. 1A). There was no evidence of intestinal obstruction. Gastro-intestinal films were then obtained, but unfortunately surgical exploration was performed prior to their interpretation. The reported operative finding was duodenal obstruction by an indurated mass including the omentum, diagnosed grossly as a malignant neoplasm. A gastro-enterostomy was performed. Subsequent interpretation of the gastro-intestinal films showed an unusually large rounded duodenal bulb with a central lobular defect. The biliary tree was partially filled by barium through a fistulous opening between the duodenal bulb and the fundus of the gallbladder (Fig. 1B).