Barium Enema Radiography Research Articles

Diagnosing Pediatric Intussusception Through Bedside Ultrasound by Novice Emergency Department Sonographers: A Case Report

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.

A population-based study of the extent of colorectal cancer screening in men with HIV

BackgroundBecause of the increased life-expectancy of persons with HIV, the need for age-appropriate colorectal cancer screening among these patients will increase. We examined rates of colorectal cancer screening among HIV-infected men aged 50 to 65 years.MethodsWe used Ontario’s administrative databases to identify all men between the ages of 50 and 65 years who were alive on April 1, 2007, and identified HIV-infected men using a validated case-finding algorithm. We excluded men with a history of colorectal cancer, anal cancer, inflammatory bowel disease and any colorectal investigation in the preceding five-years, and used multivariable regression to compare rates of colorectal cancer screening between men with and without HIV during five years of follow-up.ResultsWe identified 743,801 men between the ages of 50 and 65 years, of whom 1,432 (0.19%) were HIV-infected. The proportions of men with and without HIV who underwent any screening during the 5-year follow up period were 49.1% (95% CI 46.5% to 51.7%) and 41.4% (95% CI 41.3% to 41.5%), respectively. Compared with HIV-negative men, men with HIV had lower rates of fecal occult blood testing [adjusted rate ratio (aRR) 0.74; 95% confidence interval (CI) 0.63 to 0.87] and barium-enema radiography (aRR 0.66; 95% CI 0.39 to 1.12), but higher rates of colonoscopy (aRR 1.24; 95% CI 1.13 to 1.37), flexible sigmoidoscopy (aRR 1.72; 95% CI 1.28 to 2.30) and rigid sigmoidoscopy (aRR 2.98; 95% CI 2.26 to 3.93).ConclusionAs with the general population of men aged 50 to 65 years, less than half of the population of men with HIV received colorectal cancer screening. Strategies are required to improve uptake of this intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0711-9) contains supplementary material, which is available to authorized users.

Experience of Barium Enema Radiography in Mass Survey Procedure

大腸がん検診の二次検査に多くの施設では，全大腸内視鏡検査が実施されているが，私どもは注腸X線造影法を過去6年間用いて実施しており，その結果を比較報告する。 注腸X線造影法は精密検査受診率が内視鏡検査より極めて高く，放射線技師でも技術を磨くことで，医師にも勝るとも劣らないパワーを発揮することができるため，多数の地域住民検診希望者の需要に応じることが可能であった。また大腸がんの発見率が内視鏡検査に比べて落ちるのではないかという心配は，大腸がん発見率が新潟県平均よりはやや劣るが全国平均よりは高いこと，早期がんの割合が新潟県・全国と同程度の割合で検出されていることにより，また小さながんが見逃されるのではないかという心配は，種々の体位での撮影とガン好発部位の2回以上の撮影により払拭されている。 なお，私どもは注腸X線検査を精密検査，内視鏡検査をさらなる確定検査の手段と考えており，胃がん検診の直接X線撮影と同様に位置付けている。従って注腸X線造影法ではっきりとした所見が見いだされなくとも，痔などの出血源が見当たらない症例には積極的に内視鏡検査を奨めることにしている。

Rectosigmoid Ectasia Associated with Anorectal Anomaly Repair: Experience with Sigmoid Anterior Resection and Endorectal Pull-Through

Surgical treatment of anorectal anomalies may be followed by severe constipation with or without overflow incontinence secondary to dilation and ectasia of the rectosigmoid. The aim of this study is to evaluate the efficacy of anterior resection and endorectal pull-through for the treatment of rectosigmoid ectasia secondary to posterior sagittal anorectoplasty (PSARP). Seven patients with a history of PSARP presented with serious rectosigmoid ectasia and overflow incontinence of fecal impaction. Four were boys and 3 were girls aged from 16 months to 15 years. Preoperative diagnosis was based on physical examination, barium enema, MRI and rectal biopsy. Surgical treatment of the post-PSARP rectal ectasia was made by anterior resection of the ectatic segment of the sigmoid combined with pull-through of normal colon into the mucosectomized ectatic rectum. During a four-to ten-year follow-up period all of our patients had normal bowel movements. Postoperative barium enema radiography demonstrated a normal rectal caliber and manometry revealed normal anorectal motor function. The good postoperative results draw attention to the following. a) The aim of the surgical treatment of megarectum is to establish a neorectum with normal bowel. b) Resection of megasigmoid and pull-through of bowel with normal caliber into the mucosectomized ectatic rectum is an effective procedure in patients with post-PSARP rectosigmoid ectasia. c) The neorectum attains its reservoir function through a gradual process after resection and endorectal pull-through.

Longitudinal colonic torsion as a cause of tenesmus in an adult Irish Water Spaniel

CASE HISTORY: Torsion of the descending colon was diagnosed by barium enema radiography in an adult Irish Water Spaniel which had presented with tenesmus of 24 h duration. Treatment involved exploratory laparotomy, repositioning of the colon, colopexy and repair of a mesenteric rent. No definitive cause of the torsion could be established. The dog made an uneventful recovery from surgery. CLINICAL RELEVANCE: Animals presenting with constipation of undetermined cause should have large intestinal obstruction ruled out prior to administering bowel cleansing solutions per os and/or colonic enemas. Colonic obstruction by torsion should be considered as a possible differential diagnosis in all cases of tenesmus.

Colorectal Cancer Screening: A Community Case-Control Study of Proctosigmoidoscopy, Barium Enema Radiography, and Fecal Occult Blood Test Efficacy

To examine the effectiveness of screening proctosigmoidoscopy, barium enema radiography, and the fecal occult blood test (FOBT) in decreasing colorectal cancer mortality in a community setting. In this population-based case-control study, cases comprised 218 Rochester, Minn, residents who died of colorectal cancer between 1970 and 1993. Controls were 435 age- and sex-matched residents who did not have a diagnosis of colorectal cancer. Screening proctosigmoidoscopy, barium enema radiography, and FOBT results were documented for the 10 years prior to and including the date of diagnosis of fatal colorectal cancer in cases and for the same period in matched controls. History of general medical examinations and hospitalizations was also recorded. Within the 10 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening proctosigmoidoscopy were 23 (10.6%) of 218 cases vs 43 (9.9%) of 435 controls; at least 1 screening barium enema radiographic study was done in 12 (5.5%) of 218 vs 25 (5.7%) of 435. Within 3 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening FOBT were 27 (12.4%) of 218 vs 44 (10.1%) of 435. Adjusted odds ratios were 1.04 (95% confidence interval [CI], 0.21-5.13) for proctosigmoidoscopy (distal rectosigmoid cancers only), 0.67 (95% CI, 0.31-1.48) for barium enema radiography, and 0.83 (95% CI, 0.45-1.52) for FOBT over the above time periods. In this case-control study within a community setting, a colorectal cancer-specific mortality benefit could not be demonstrated for screening by FOBT, proctosigmoidoscopy, or barium enema radiography. Screening frequency was low, which may have contributed to the lack of measurable effects.

A man with a leg-vein clot and colonic ulcers

A 48-year-old man was admitted to hospital on May 28, 1995, with spasms of lower abdominal pain of variable intensity for 5 weeks, associated with weight loss. He had had a pulmonary embolism after a deep-vein thrombosis 15 years previously. 2 years before admission, he had had pancreatitis of unknown cause. 1 year before admission, colonoscopy had shown a segmental ulcer in the midtransverse colon. He had a segment of colon removed. Histological examination did not establish a cause for the ulcer. He continued to complain of recurrent lower abdominal pain and weight loss. Angiography of his mesenteric arteries was normal. Barium enema radiography of the colon showed a cicatricial stenosis in the mid-transverse colon at the site of the previous resection. This was removed at operation. Histological examination showed a segmental ulcer of unclear cause. After discharge from hospital he still had lower abdominal pain, especially after food. At our institution, physical examination showed he was 180 cm in height and weighed 60 kg. There was paraumbilical tenderness, but no other abnormalities. Repeated stool cultures were negative. Colonoscopy showed a segmental ulcer in the right side of the transverse colon. The ulcer was shallow and 10 cm in diameter. Colonic mucosa at the borders of the ulcer was friable and had petechial haemorrhages. The remainder of the colonic mucosa appeared normal (figure). Ten biopsy specimens were taken. The crypts were of normal height in three specimens and hyperplastic in one. The lamina propria contained normal numbers of lymphocytes and plasma cells and no granulocytes. Six specimens showed granulation tissue and inflammatory cells at the base of an ulcer. The lesion was consistent with an ischaemic ulcer. Histological slides from the second resection of his colon at another hospital showed similar findings. The diagnostic feature was thrombosis of small submucosal and mesenteric vessels, consistent with mesenteric thrombosis. An examination of the clotting system showed resistance to activated protein C, 1 caused

Mucosal Microcirculation in Juvenile Polyps in Children

To the Editor: Impairment of microcirculation in the gastrointestinal mucosa is known to play an important role in cases of mucosal injury, not only from local ischemia resulting in cellular hypoxia (1) but also from over-production of oxygen radicals, eicosanoids, and platelet-activating factor (2,3). Developments in spectrophotometric techniques have made possible in vivo, noninvasive assessment of the concentration of hemoglobin and levels of oxygenation in the gastrointestinal mucosa in adult patients using gastrointestinal fiberscopy (4-6). However, there have been no reports of this kind of evaluation in children. We measured the mucosal microcirculation in colonic polyps and in the normal surrounding colon using reflectance spectrophotometry during colonofiberscopy in four children with juvenile polyps. Four patients aged from 1.5 to 6 years were studied. The patients had melena, and barium enema radiography revealed colonic polyps. All patients had a single polyp of maximum diameter 12-30 mm located between the transverse colon and the rectum. Colonofiberscopy was used to perform polypectomy under systemic anesthesia. During this operation, the mucosal microcirculation in the polyp and in the normal surrounding colon was evaluated using reflectance spectrophotometry. The hemoglobin concentration and the levels of oxygenation were measured in the mucosa using a tissue spectrum analyzer (TS-200, Sumitomo Electric Industries, Osaka, Japan). This was done using a fine optic bundle, whose tip was passed through the biopsy channel until it gently contacted the mucosal surface, following the method of Kamada et al. (4). The concentration of mucosal hemoglobin in the polyp mucosa was significantly higher (p < 0.05) than that in the normal surrounding mucosa. In contrast, the amount of mucosal oxygen in the polyp mucosa was typically less (p < 0.1) than that in the normal surrounding mucosa (Fig. 1). Histological examination of the polyps showed typical findings of juvenile polyps. Reflectance spectrophotometry can evaluate the concentration of hemoglobin in the gastrointestinal mucosa and the levels of oxygenation during endoscopical examination (4-6). These microcirculatory parameters are known to be indicators of mucosal ischemia, congestion, and other disturbances of the gastrointestinal mucosal microcirculation that can cause mucosal injury of the gastrointestinal tract. Our findings showed that the mucosal hemoglobin concentration in the juvenile polyp was markedly more than normal but the levels of oxygenation were typically less than normal. These findings indicate congestion in the mucosal microcirculation in juvenile polyps. This is in accordance with our histological findings, which showed hypervascularity in the veins and capillaries of the polyps. Further, this study suggests that it is feasible to assess the relationship between mucosal microcirculation and mucosal injury in children, as well as adults, using in vivo measurement of the gastrointestinal mucosal microcirculation with reflectance spectrophotometry (4-6). Toshiaki Shimizu, Yuichiro Yamashiro, Atsushi Unno, Kaoru Obinata, Keijiro Yabuta, and *Tatsuo Ogihara Department of Pediatrics *Division of Gastroenterology Department of Internal Medicine Juntendo University School of Medicine Tokyo, JapanFIG. 1.: Index of mucosal blood volume (•) and oxygenation (○) in the mucosa of colonic polyps and of normal surrounding colon in four children with juvenile polyps. Means were compared using a paired t test.

The effects of distention of the colon during air-contrast barium enema on colonic morphology: anatomic correlation.

Radiologic and pathologic findings are snapshots of disease processes that may vary with a host of dynamic variables. This pictorial essay shows how the presence and visibility of the innominate grooves of the colon are a function of colonic distention. This article also shows how each layer of the colonic wall, including the epithelium, muscularis mucosae, and muscularis propria, changes dramatically in thickness with varying degrees of colonic distension. These anatomic changes are documented by barium enema radiography, specimen radiography, dissecting photomicrography, and histology. These observations have important implications for the interpretation of radiologic and pathologic findings in both normal and diseased states.

Intestinal Behçet disease: serial changes at radiography.

To clarify the characteristic radiographic findings and serial radiographic changes in nonsurgical cases of intestinal Behçet disease (BD), seven patients were followed up for an average of 4 1/2 years (range, 8 months to 11 years 4 months). They underwent repeated examination with barium meal studies and double-contrast barium enema meal studies and double-contrast barium enema radiography. Initial radiography revealed one to three deep ulcers in the terminal ileum or ileocecal region in five patients. The ulcers healed while patients were treated with medical therapy but recurred during the follow-up period. In four of these five patients, follow-up radiography demonstrated various changes within each case: At each examination, an enlarged ulcer or a newly developed ulcer was often found in conjunction with a healed ulcer. In the other two patients, multiple shallow ulcers or innumerable aphthoid ulcers were seen throughout the entire colon, and these ulcers showed a good response to medical treatment. These results indicate that serial radiographic changes in patients with intestinal BD may mimic those in patients with Crohn disease, with findings in the terminal ileum and colon that wax and wane with medical treatment.

410. 注腸 X 線写真評価基準の検討(X 線検査-10 上部消化管検査 大腸)

410. 注腸 X 線写真評価基準の検討(X 線検査-10 上部消化管検査 大腸)

Perforation of the rectum and sigmoid colon during barium-enema examination. Management and prevention.

Perforation of the rectum or sigmoid colon complicated 5 of 2200 barium-enema examinations performed during a 4-year period. Three patients with rectal perforations manifested by air extravasation were successfully treated with intravenous antibiotics and complete bowel rest. Two patients with barium extravasation were treated with immediate operation and colostomy. All five patients recovered. Perforation was found to be associated with a rectal stricture due to ulcerative colitis, a rectal cancer, an incarcerated inguinal hernia, fulminant ulcerative colitis, and a normal colon in an elderly patient. To determine the pressure in the rectum that could potentially be generated during a barium-enema examination, the pressures created by a standard barium delivery set were measured, using 1-meter columns of water, 25 percent diatrizoate sodium (Hypaque), 20 percent barium, and 80 percent barium. The columns generated pressures of 70, 85, 95, and 120 mm Hg respectively. Squeezing the delivery bag increased the pressure 21 to 79 percent or a maximum of 55 mm Hg. Colorectal perforation during barium-enema examination that was not accompanied by barium extravasation could be successfully treated nonoperatively. The associated pathology and our studies of pressures generated during a barium-enema examination allow us to suggest that the incidence of colorectal perforation during barium-enema radiography can be reduced by 1) performing proctoscopy prior to barium enema, 2) avoiding the use of the rectal balloon in patients with known rectal lesions, 3) avoiding barium studies in patients with active colitis, 4) avoiding generation of pressure greater than that created by a column of barium suspension of one meter, and 5) using a lower concentration of barium when possible.

Familial, recurrent hemolytic-uremic syndrome

Age (yr) 13 15 12 Sex M M F Duration of typical pain attack 1-2 min <3 min Few seconds Pain frequency (episodes/yr) 6 7-8 Unknown Character of pain Sudden, stabbing Sudden, crampy Sudden, crampy Associated GI symptoms None None None Past history of recurrent abdominal pain + + Familial irritable bowel syndrome + Physical examination Normal Normal Normal Barium enema radiography Normal Normal Normal Rectosigmoidoscopy Normal Not done Not done Multiple drug trials + +

Energy and rate dependence of diagnostic x-ray exposure meters.

Variations in x-ray exposure measurements among a variety of contemporary diagnostic exposure meters are investigated. Variations may result from systematic errors due to calibration, beam-quality dependence and exposure-rate dependence. It is concluded that the majority of general purpose diagnostic meters will agree to within 10% of each other if exposure rates are below 1.3 mC kg-1S-1 of air (5 R s-1) and beam qualities are typical for general purpose radiology, excluding mammography. For exposure rates comparable to those in barium enema radiography the variations can range up to 25% or more. Variations up to 40% were observed among general purpose exposure meters at mammographic beam qualities. In the mammographic range, mammographic (thin window) exposure meters varied by no more than 2%.

Computed tomographic distinction of submucosal lipoma and adenomatous polyp of the colon

Described here is a patient with 2 large pedunculated colonic tumors detected by barium enema radiography. By computed tomography (CT) 1 was found to be a submucosal lipoma characterized by oval shape, smooth demarcation, and homogeneous density with a CT number of -68 HU, whereas the other was an adenomatous polyp with slightly fuzzy outline and a much higher CT number. This case indicates that CT can be a definitive diagnostic modality for distinguishing between a colonic lipoma and other solid or cystic tumor of the colon.

Necrotising enterocolitis experience with 54 neonates.

Fifty-four neonates transferred to the neonatal surgical unit because of acute necrotising enterocolitis (N.E.C.) are presented. Eleven died (20.4%), of whom seven were treated conservatively and four by operation. Ten patients required surgical exploration because of intestinal perforation, obstruction or suspected perforation. Another five neonates presented with intestinal perforation and were treated by percutaneous catheter drainage of the peritoneal cavity because of their extreme prematurity. Nine patients developed a colonic stricture diagnosed between six weeks and a year after the onset of the disease. Another six patients showed a segment of colonic narrowing detected on barium enema radiography without clinical evidence of bowel obstruction. They were treated conservatively and showed complete resolution at follow up studies.

The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis.

The traditional work-up of patients with lower left quadrant peritonitis often includes the eventual use of barium-enema radiography. Diagnosis is usually delayed until adequate patient stabilization allows diagnostic contrast enemas. Delay of accurate diagnosis may, at times, have serious clinical sequelae. The use of barium enema in acute lower left quadrant peritonitis has both theoretic and actual disadvantages. These include extravasation of barium, with resultant barium cellulitis and peritonitis, precipitation of acute obstruction, and delay in evaluation by endoscopy, sonography, computerized tomography, and angiography. Forty recent cases of lower left quadrant peritonitis were evaluated on admission by water-soluble contrast enema. Water-soluble contrast enemas appear to be safe and accurate and avoid the aforementioned disadvantages of barium.

Postoperative evaluation of fecal continence after sphincter-preserving operations for rectal cancer.

Seventy-eight sphincter-preserving operations for rectal cancer were evaluated from the viewpoint of postoperative fecal continence. Operative procedures consisted of 39 anterior resections and 39 pull-through operations and Maunsell-Weir's operation. Postoperative fecal continence was evaluated by questionnaires and anorectal examinations including (1) the distance from the anal verge to the anastomosis, (2) the length of sensation to light touch in the anal canal, (3) electromyography of the sphincter, (4) internal sphincter reflex (5) pressure profile of the anal canal, and (6) barium enema radiography. Patients' evaluations of their continence were good when the distance of the anastomosis was over 5 cm from the anal verge, and mostly poor under 3 cm. Good or fair evaluations were obtained when the internal sphincter reflex or high pressure zone of the anal canal were preserved. Size of the reservoir was measured using a planimeter on the lateral view of the barium enema up to 6 cm from the upper margin of the anal canal. Good or fair evaluations were obtained when size was 30 cm2.

Clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis.

Thirty patients with antimicrobial agent-associated pseudomembranous colitis (PMC) were studied for the presence of Clostridium difficile and its cytotoxin in feces. Either colonoscopy or barium enema radiography was required in three patients for the diagnosis of PMC because of nondiagnostic findings at sigmoidoscopy. Both the organism and cytotoxin were detected in 27 of the 30 patients; Staphylococcus aureus was excluded as the cause of PMC in two of the remaining patients. Eighteen of 19 patients with C. difficile-induced PMC who were treated with oral vancomycin had a salutary response; seven patients, however, had a relapse of colitis following the discontinuation of vancomycin. In general, relapses of colitis responded to retreatment with vancomycin. The implication of C. difficile as a cause of diarrhea is best achieved by the demonstration of colonic mucosal plaques or of a pseudomembrane. The value of fecal culture for C. difficile and cytotoxin assay is limited by the existence of asymptomatic carriers.