Barium Meal Study Research Articles

Recurrent ulcer after vagotomy and pyloroplasty: the x-ray appearances and their value in diagnosis.

Barium meal studies have shown evidence of a recurrent ulcer or of stenosis in 12 out of 24 patients with recurrent dyspepsia after vagotomy and pyloroplasty. These 12 patients have been subsequently proved to have had recurrences and all but one are now cured by further surgery. Barium meals in 12 patients show no evidence of recurrence or stenosis, and follow-up clinical studies suggest that they do not have recurrent ulcer. Radiological studies appear to have great value in the interpretation of recurrent dyspeptic symptoms after vagotomy and pyloroplasty.

Pancreatic pseudocyst in a 4-year-old child

Pancreatic pseudocyst is a localized fluid collection that is rich in amylase and other pancreatic enzymes and is surrounded by a wall of fibrous tissue. Pseudocysts are connected to the pancreatic ductal system, through the pancreatic parenchyma. It is caused by pancreatic ductal disruption either due to stenosis, calculi, or protein plugs obstructing the main pancreatic ductal system or as a result of pancreatic necrosis following an attack of acute pancreatitis. Pseudocysts are a common clinical problem and complicate the course of chronic pancreatitis in 30%–40% of patients but rarely seen in children. A case of a 4yr old who presented with abdominal swelling and vomiting. His initial diagnosis after a barium meal study was retrogastric mass such as duplication cyst/mesenteric cyst. However, ultrasound scan confirms a diagnosis of pancreatic pseudocyst. The case is here presented with a literature review.

Vagotomy and pyloroplasty: a cineradiographic study.

Cine barium-meal studies have been carried out on 29 patients following a Heineke-Mikulicz pyloroplasty and on 13 after a Finney pyloroplasty. All patients had a vagotomy and all were asymptomatic. In both groups, constant gastroduodenal deformity was observed: in those who had a Finney procedure, a translucent line indented the barium-filled stomach, probably owing to a ridge of tissue at the suture line; in those patients who had a Heineke-Mikulicz procedure, large pseudodiverticula were observed in the pyloric canal and muscular impressions indented the canal. The pseudo-diverticula occur in the normal postoperative state but must be differentiated from peptic ulcers.

Choledochal cyst: Report of five cases

Five cases of choledochal cyst occurring in childhood are discussed with pertinent roentgenographic and clinical findings. The clinical manifestations were (1) in early infancy—obstructive jaundice, and (2) in children—the classical triad of jaundice, abdominal pain and mass. The most valuable roentgenographic findings were (1) on plain film of the abdomen—mass in the right upper quandrant., (2) on barium meal study—anterior, inferior and left sided displacement of gastric antrum and duodenal bulb, (3) lateral displacement of descending duodenum, and (4) inferior displacement of the third portion of the duodenum. Direct demonstration of the cyst may be accomplished by intravenous cholangiography, direct percutaneous cystography, and possibly oral cholecystography.

INNOMINATE GROOVES IN THE SURFACE OF MUCOSA.

Dassel (1962), under the title of speculation of the colon, drew attention to small V-shaped notches projecting from the edge of the colon in barium enema pictures. Like many observers, after a period of mistaking them for tiny ulcers, he came to realize they were a normal phenomenon and ascribed them to barium entering the glands of Lieberkühn. This paper extends his observations, correlates them with a similar phenomenon seen at barium meal studies, and offers a slightly different anatomic explanation. The material is derived from routine barium work and from the examination of normal areas of operative specimens of the stomach and colon. The Colon Anatomy: Figure 1 is a three-dimensional drawing of the normal colon wall from Bloom and Fawcett's Textbook of Histology. The mucosal glands of Lieberkühn in this picture are drawn at about 8 to the millimeter. In addition, the artist has indicated a series of un-named grooves in the mucosal surface about 0.5 mm apart. Figure 2, a longitudinal section of distended colon crossing the grooves at right angles, shows the relative widths of these two structures. The mouths of glands may open into the grooves or have a free opening onto the surface of the mucosa. In an operative specimen of the colon the grooves can be seen with the naked eye to form a recognizable pattern. This is made prominent in Figure 3 by outlining with India ink. The majority run circumferentially, remaining roughly parallel, but with some interlocking. Small pits are sometimes produced where two converging pairs give rise to a crossroads effect. This is the common distribution, but in some specimens there is no convergence and occasionally the direction may seem longitudinal rather than circumferential. It is difficult to give an exact measure of their frequency since this depends, among other things, on the distention of the colon, but perhaps 0.5 to 2 mm apart is a reasonable estimate. The glands of Lieberkühn are deployed at several to the millimeter in a moderately distended piece of gut. Radiology: The innominate grooves are deep enough to retain barium and are thus visible on radiographs. Three pictures are seen. In Figures 4, A, 5, and 6, as they pass on the horizon of the filled colon they appear as V-shaped projections 1 to 3 mm apart and about 0.5 to 1 mm deep. In air-contrast pictures they give rise to a network of interlocking, circumferentially directed lines as in Figures 4, B and 6, and it is not uncommon to see the network running to the surface to link up with the notches. Where in the filled picture the notches are prominent, the after-evacuation pattern may be interspersed with dots (Figs. 4, C and 7). This appearance is compatible with barium being retained at some junctions in the network, although a technic has not been developed to show this convincingly, and it remains an empirical association already noted by Dassel (1962).

Lymphangiography and Chromosome Studies in Females with Lymphoedema and Possible Ovarian Dysgenesis

In primary lymphoedema, lymphangiography has revealed abnormalities ofthe lymphatics. Kinmonth (1960), in a series of 192 patients, found hypoplasia of the lymphatic trunks in 65%, aplasia in 15%, varicose dilatation in 14 %, and backflow of dye into the lymphatic dermal plexus in 6 %. These findings suggested that primary lymphoedema was due to congenital error in the development of lymphatics. Congenital peripheral oedema occurs in a proportion of patients with ovarian dysgenesis and allied disorders. A history of oedema was obtained in 45 out of 126 patients (35 * 7 %) under the age of 16, but only in 4 of 120 (3 3%) over the age of 16 (Bishop, Lessof, and Polani, 1960); it was present in 9 of the 51 (17 6%) patients reported by Lindsten (1963). The course of oedema in ovarian dysgenesis differs from that of other types of lymphoedema. Thus in primary lymphoedema, oedema is stationary or slowly progressive, while in ovarian dysgenesis it disappears in a few months or years in the majority of cases. Occasionally, however, it persists or recurs at puberty or after administration ofoestrogens or anabolic steroids. In this article we report the result of lymphangiography and chromosomal analysis in six patients with lymphoedema who were phenotypically female and who had clinical evidence of ovarian dysgenesis. Lymphangiography was carried out at St. Thomas's Hospital. Recent advances in the technique of lymphangiography have been published elsewhere (Gough, Guiney, and Kinmonth, 1963) and will not be repeated here. The chromosome analysis, after blood or skin culture, was carried out by one of us (P.E.P.) with the help of other members of the cytogenetics section of the Paediatric Research Unit, Guy's Hospital Medical School. Cases Case 1. (P.R.U. 794). Phenotypic female with congenital lymphoedema ofhands andfeet, webbing of neck. Sex chromosomes XO. Hypoplasia oflymphatic trunks of feet and of superficial lymphatics of legs. Anomalous lymph vessels at ankles. Congenital pitting oedema of hands and feet gradually subsided and disappeared by 3 years. She had been born after a normal pregnancy and delivery, weighing 2,800 g. Her parents and sister were healthy. The diagnosis of mild congenital hypertrophic pyloric stenosis was suspected clinically and supported by visualization of an elongated pylorus on barium meal studies. A brother had had congenital hypertrophic pyloric stenosis, confirmed at operation, and another brother had had the same condition diagnosed on clinical grounds. Her toe-nails were hypoplastic and she had webbing of the neck. At 9 months of age, she was 65 5 cm. tall (3rd percentile) and weighed 6 * 6 kg. (less than 3rd percentile). Chromosomes: number 45; sex chromosome3 complement XO; chromatin negative on nuclear sexing. LYMPHANGIOGRAPHY. At 2 years and 10 months, incisions were made on the dorsum of each foot. A fine spongy network of lymphatics was seen in the subcutaneous tissue. Biopsy of this tissue confirmed the presence of multiple minute lymph vessels without valves. In the normal subject at this site there are three or four small discrete lymphatic vessels running in the subcutaneous tissue, immediately below the skin. Further incisions were made in the skin over the dorsum of the ankles. On the left, several larger but abnormal lymphatics were seen that were too small to cannulate. On the right there were several vessels running superficial to the deep fascia before piercing it. In spite of the quantity of patent blue in the subcutaneous lymphatic plexus, these deep vessels were only slightly coloured, suggesting a poor circulation between the superficial and deep lymphatic systems. With the aid of a dissection microscope, a size 30 hypodermic needle was inserted in one of the vessels on the deep fascia, and 3-5 ml. of ultrafluid Lipiodol (Bengue) were injected.

Incidence of asymptomatic steatorrhea in adults. A preliminary report.

1. A survey of 230 essentially well patients by use of the serum carotene level as a screening index, disclosed five asymptomatic patients in whom gross steatorrhea was present—an incidence of 2.3 per cent. 2. Other tests for determining abnormality of small-bowel function, such as radioactive triolein,D-xylose urinary excretion and, barium meal studies correlated rather poorly with the chemical determination of stool fat. 3. Serum carotene level is considered to be a simple and efficient method of screening for steatorrhea. 4. It is suggested that asymptomatic steatorrhea is a more frequent occurrence than has been suspected.

Pyloric Antral Mucosal Diaphragm with Transpyloric Mucosal Prolapse

Five cases of pyloric antral mucosal diaphragm are reported in the literature (1-5). To these we wish to add a case which was complicated by transpyloric gastric mucosal prolapse. The diaphragm, we believe, prevented the normal cephalad movement of the gastric mucosa during peristalsis (Golden's phenomenon). It therefore remained“trapped” in the antrum and its prolapse into the duodenum was easily demonstrated. Case Report A 62-year-old white male consulted his physician (R. E. C.) on Sept. 14, 1957, two days after the sudden development of severe pain in the right upper quadrant of the abdomen. This was accompanied, twelve hours after the onset, by the passage of approximately one ounce of bright red blood per rectum. The pain radiated to the back and was not influenced by eating. There was no history of nausea, vomiting, or weight loss. Physical examination showed spider nevi over the anterior chest wall, enlargement of the liver 4 cm. below the costal margin, a reducible right inguinal hernia, and a slightly enlarged smooth right lateral prostatic lobe. Proctoscopic examination revealed internal hemorrhoids without evidence of recent bleeding. No evidence of organic disease was obtained by barium enema studies. Pertinent laboratory findings were occult blood in the stool (4+), absence of free HC1, and presence of lactic acid in the gastric contents. Barium meal studies on Nov. 5, 1957, revealed no abnormality in the esophagus, but a constant zone of narrowing was encountered in the distal stomach 2.5 cm. proximal to the base of the duodenal bulb (Fig. 1). The narrowed segment measured 2 to 3 mm. in length, and the luminal diameter was approximately 8 mm. No rugal pattern was recognizable adjacent and cephalad to the diaphragm. Thickened rugae, however, were discernible in the“compartment" between the collar-like narrowing and the pyloric canal, prolapsing into the duodenum during antral systole (Fig. 1). During the prolapsing phase the“compartment" was considerably shortened (approximately 10 to 15 mm.). The duodenum was otherwise essentially normal. The diagnosis was“a diaphragm-like structure in the pyloric antrum with transpyloric mucosal prolapse.” Surgical exploration by Dr. Guzzetta at Misericordia Hospital (Milwaukee) on Nov. 20, 1957, revealed an area of thickening in the antrum of the stomach. Gastrotomy disclosed a hymen-like membrane in the distal antrum, and resection of the distal half of the stomach was performed. Following operation upper abdominal complaints ceased except for one episode of upper abdominal fullness in December 1957. The patient is now suffering from inoperable (fibro ?) sarcoma involving the right chest and is expected to succumb to this disease. Exploratory thoracotomy was done at Milwaukee County General Hospital, Wauwatosa, Wise.

Diverticula of the jejunum with massive hemorrhage.

The differential diagnosis of hematemesis and melena includes many diseases of the entire gastrointestinal tract. One of the more unusual sources of such hemorrhage is diverticula of the jejunum. The first description of diverticula of the jejunum was made in 1844 by Cooper.6The patient was about 50 years old and had died of other causes. When the autopsy was done, numerous pouches were found in the greater part of the jejunum, situated chiefly between the layers of the mesentery. The incidence of diverticulosis of the jejunum is low. Gordinier and Sampson11described a patient with partial intestinal obstruction due to diverticulitis occurring in a pouch located in the upper ileum or the lower jejunum. The authors collected the reports of 14,068 autopsies and found acquired diverticula of the small intestine in 16. Case5reported 5 such instances in 6847 patients in whom complete barium meal studies,

Aberrant Pancreatic Tumor in the Duodenal Wall

According to Ewing, the duodenum is the common site for aberrant pancreatic tissue, which infrequently gives rise to a new growth. Such a case has recently come under our observation. Because of the rarity of the lesion and the interesting x-ray findings, we believe that it merits a detailed report. Mrs. I. S., age 64, was admitted to the Jewish Hospital on Dec. 10, 1942, because of pain in the abdomen, loss of appetite, “sour stomach,” and frequent vomiting during the preceding two months. The physical examination revealed no palpable masses in the abdomen. There was some tenderness in the region of the epigastrium upon deep pressure. Clinical laboratory studies showed nothing remarkable. A complete x-ray study of the gastro-intestinal tract was carried out. A plain view of the abdomen showed no dense shadows in the region of the gallbladder suggestive of stones. After the oral administration of tetraiodophenolphthalein sodium dye the gallbladder failed to fill. A barium-meal study showed the stomach to ...

Studies on the neutralization of gastric acidity: Ewald test meal and X-ray (barium meal) studies in patients with duodenal ulcer, gastro-jejunostomy and gastric resection

1. Gastric studies of 25 patients were made by means of x-ray (after a barium meal), fractional Ewald test meals and neutralization curves of gastric acidity. The patients comprised those with x-ray evidence of ulcer, both with and without symptoms, those with symptoms of ulcer but with negative x-ray findings, and those with gastro-enterostomies and gastric resections.

THE VALUE OF A NEUTRALIZATION TEST OF GASTRIC ACIDITY IN PATIENTS WITH DUODENAL ULCERS AND SO-CALLED PYLOROSPASM

Article1 April 1934THE VALUE OF A NEUTRALIZATION TEST OF GASTRIC ACIDITY IN PATIENTS WITH DUODENAL ULCERS AND SO-CALLED PYLOROSPASMJEROME S. LEVY, M.D.JEROME S. LEVY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-7-10-1244 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe equivocal value of analyses of gastric contents in the study of peptic ulcer is probably due to the lack of uniformity of the findings resulting from the use of the ordinary test meals. Such studies on gastric secretory function have been concerned almost entirely with the measurements of the response to a stimulus in the form of some type of a test meal or, more recently, to the injection of histamine. The response is determined by the amount of acid, of chloride and of pepsin recovered in the stomach contents. The widely divergent results of these observations have naturally...Bibliography1. PAVLOV IP: The work of the digestive glands, 1910, Charles Griffin and Co., London, p. 32. Google Scholar2. CARLSON AJ: Contributions to the physiology of the stomach. XXV. A note on the chemistry of normal human gastric juice, Am. Jr. Physiol., 1915, xxxviii, 248-268. CrossrefGoogle Scholar3. BOLDYREFF W: Einige neue Seiten der Täkigkeit des Pankreas, Ergebn. d. Physiol., 1911, xi, 121-217. CrossrefGoogle Scholar4. MACLEANGRIFFITHS HWJ: Automatic regulation of gastric acidity, Jr. Physiol., 1928, lxvi, 356-370. CrossrefGoogle Scholar5. MCCANN JC: Experimental peptic ulcer, Arch. Surg., 1929, xix, 600-659. CrossrefGoogle Scholar6. BOLTONGOODHART CGW: Variations in acidity of gastric juice during secretion, Jr. Physiol., 1931, lxxiii, 115-135. CrossrefGoogle Scholar7. ELMAN R: Probable influence of pancreatic juice in regulation of gastric acidity, Arch. Surg., 1928, xvi, 1256-1265. CrossrefGoogle Scholar8. ELMAN R: Behavior of gastric acidity in duodenal ulcer and pyloric obstruction before and after gastro-enterostomy, Surg., Gynec. and Obst., 1929, xlix, 34-42. Google Scholar9. ELMANROWLETTE RAP: Rôle of pyloric sphincter in behavior of gastric acidity, Arch. Surg., 1931, xxii, 426-437. CrossrefGoogle Scholar10. ELMANHARTMANN RAF: Spontaneous peptic ulcers of duodenum after continued loss of total pancreatic juice, Arch. Surg., 1931, xxiii, 1030-1040. CrossrefGoogle Scholar11. OLCH IY: Duodenal regurgitation as factor in neutralization of gastric acidity, Arch. Surg., 1928, xvi, 125-138. CrossrefGoogle Scholar12. ROBERTS WM: Action of belladonna and neutral fats on acidity of stomach contents, Quart. Jr. Med., 1925, xix, 74-85. CrossrefGoogle Scholar13. MORTON CB: Peptic ulcer, Ann. Surg., 1927, lxxxv, 207-238. CrossrefGoogle Scholar14. PORTISPORTIS BSA: Effects of subtotal gastrectomy on gastric secretion; experimental studies by aid of Powlow pouch in dogs, Jr. Am. Med. Assoc., 1926, lxxxvi, 836-839. CrossrefGoogle Scholar15. APPERLYCAMERON FLG: New test for pancreatic efficiency, Med. Jr. Australia, 1923, i, 521-524. CrossrefGoogle Scholar16. PALMER WL: "Acid test" in gastric and duodenal ulcer; clinical value of experimental production of typical distress, Jr. Am. Med. Assoc., 1927, lxxxviii, 1778-1780. Google Scholar17. HUGHSON W: Relation of pylorus to duration of experimental gastric ulcer, Arch. Surg., 1927, xv, 66-74. CrossrefGoogle Scholar18. MANNWILLIAMSON FCCS: Experimental production of peptic ulcer, Ann. Surg., 1923, lxxvii, 409-422. CrossrefGoogle Scholar19. BOLTON C: Diseases of stomach, with special reference to modern methods of investigation, Brit. Med. Jr., 1923, ii, 269-275. Google Scholar20. ELMANECKERT RCT: Neutralization of gastric acidity following pyloric closure, Proc. Soc. Exper. Biol. and Med., 1933, xxx, 1343-1344. CrossrefGoogle Scholar21. MATTHEWSDRAGSTEDT WBLR: Etiology of gastric and duodenal ulcer; experimental studies, Surg., Gynec. and Obst., 1932, lv, 265-286. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Little Rock, Arkansas*Received for publication January 2, 1934. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHistory and development of gastric analysis procedure (third installment)Studies on the Neutralization Test of Gastric Acidity in relation to general diseaseThe acidity reduction test versus the fractional test mealStudies on the neutralization of gastric acidity: Ewald test meal and X-ray (barium meal) studies in patients with duodenal ulcer, gastro-jejunostomy and gastric resection 1 April 1934Volume 7, Issue 10Page: 1244-1262KeywordsChloridesDuodenal ulcersHistaminePepsinsPeptic ulcersStomach ePublished: 1 December 2008 Issue Published: 1 April 1934 PDF downloadLoading ...

THE REDUNDANT DUODENUM: CLINICAL SIGNIFICANCE

Article1 March 1934THE REDUNDANT DUODENUM: CLINICAL SIGNIFICANCETHEODORE H. MORRISON, M.D., F.A.C.P., MAURICE FELDMAN, M.D.THEODORE H. MORRISON, M.D., F.A.C.P.Search for more papers by this author, MAURICE FELDMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-7-9-1126 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough anomalies of the duodenum are occasionally observed in the routine roentgenological examination of the gastrointestinal tract, little attention has been paid to them clinically. With the development of roentgenologic technic in gastroenterology, more of these conditions are being discovered and as a consequence their clinical significance is becoming recognized. Abnormalities of the duodenum are frequently overlooked during an ordinary barium meal study principally on account of the fact that the examiner concentrates his attention on the first part of the duodenum or cap. It is quite probable that, were the entire duodenum studied with the same meticulous care, many...

Roentgenologic Findings in a Case of Phytobezoar

THE term “phytobezoar” is applied to a mass found in the stomach or intestines, composed of food materials, such as skins and fibers of fruit, colloid portions of vegetables, and starch granules, with an occasional small amount of other organic material, frequently surrounding fruit seeds. The process by which these food balls are formed is not definitely understood, but it is probable that the gum and pectin contained in the persimmon and other fruit, combined with the muscular activity of the stomach, can be considered as a more or less direct cause. It is generally considered that the formation of the food ball occurs at one particular time, possibly within a few hours after the ingestion of a quantity of fruit, very often die persimmon. However, it is not unreasonable to suppose that more material may be added, and the bezoar be gradually increased in size. The usual clinical picture is that of acute gastritis occurring immediately or within a few hours after the ingestion of the fruit. In the eight cases reported recently by Hart, seven presented acute symptoms of indigestion; in the eighth case the gastric symptoms were chronic, extending over a considerable period of time. After medical treatment in which hydrochloric acid was administered, small masses were passed in the feces, which contained apparently prunes, bits of raisin skins and stems, and vegetable detritus. Following the treatment, the tumor that had been previously noticed in the epigastrium disappeared, and the symptoms subsided. The case which we wish to report gave a similar chronic history. Mr. W., age 42, occupation, farmer. The patient applied for examination and treatment of some gastric disturbance. The present trouble began four or five years ago. No idea was offered as to the cause. The distress began as a heavy sensation in the region of the stomach, sometimes in the throat, coming on three or four hours after meals. This was not a constant affair, but occurred about once a week. Since then it has gradually increased in frequency and in severity so that, for the past few months, the patient has had a gnawing, burning pain in the region of the stomach three or four hours after meals, attended by more or less belching of gas, and sour stomach. This distress was always relieved by the intake of food. Sodium-bicarbonate had not been tried. The patient never vomited any blood or passed any black, tarry stools so far as he knows. Always a fairly hearty and rapid eater, and fond of highly seasoned foods. The patient has, nevertheless, been regular about his meals. The barium-meal study revealed a decided thinning out of the barium in about the middle portion of the stomach. This area measured two and a half to three inches in diameter, and it was found on manipulation that this apparent mass could easily be made to change its position; it being possible to move it to any desired point in the stomach from cardia to pylorus.