Double-contrast Enema Research Articles

Apple-core Lesion of Colon Adenocarcinoma by Barium Double Contrast Enema

Introduction: The apple-core lesion of colon depicts stenosing appearance on imaging study. It can be caused by different etiology. In this case, we have demonstrated an apple-core lesion on barium enema and the operation result revealed adenocarcinoma of colon. Case Blog: A 64-year-old female came to our hospital presented with diffuse abdominal dull pain, distension and constipation for three days. She denied vomiting, diarrhea, fever, body weight loss or change of bowel habit. Distended abdomen and diffuse tenderness without peritoneal sign were found by physical examination. There was no leukocytosis or electrolyte imbalance. KUB showed focal dilatation of transverse colon. Computed tomography (CT) revealed irregular luminal narrowing at distal transverse colon with perifocal fat stranding (Figure 1), suggestive of malignancy change. However, the initial pathology of biopsy via colonscopy was chronic non-specific colitis. Further barium double contrast enema was scheduled and showed apple-core lesion (Figure 2) over distal transverse colon. Finally, operation was arranged and the pathology elucidated adenocarcinoma of colon. The patient is well in our regular follow-up visiting. Discussion: The apple-core lesion of colon may be caused by a variety of diseases, such as adenocarcinoma [1,2], ischaemic colitis [3], infection [4,5], inflammatory colitis [6], endometriosis [7], and sequela of radiotherapy treatment [8]. Severe colonic lumen narrowing leads to bowel obstruction [9,10]. These differentials should be kept in mind and correlate with clinical manifestations to avoid misdiagnosis.

CT enterography with polyethylene glycol solutionvsCT enteroclysis in small bowel disease

The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease. 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n = 75) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n = 70). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel follow-through examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by χ² testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient. Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p<0.05: statistically significant difference). No significant difference was present for others sites (p>0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv). PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer

Early detection of colorectal cancer could reduce cancer-specific mortality. The aim of this trial was to evaluate the effect of faecal occult blood test (FOBT) screening on colorectal cancer mortality in a Swedish population. All 68,308 citizens in Göteborg born between 1918 and 1931 were randomized to a screening or a control group at the age of 60-64 years. All were screened two to three times with rehydrated Hemoccult-II. Compliance was 70.0 per cent (23,916 individuals). Those with a positive test result were offered sigmoidoscopy and a double-contrast enema. The primary endpoint was death from colorectal cancer. After a mean of 9 years from the last screening, there was a significant reduction in colorectal cancer mortality in the screening group compared with the control group. The overall risk ratio of death from colorectal cancer was 0.84 (95 per cent confidence interval 0.71 to 0.99). The groups did not differ in incidence of colorectal cancer or in overall mortality. FOBT screening significantly reduces colorectal cancer mortality.

Multimodality imaging of an appendiceal intussusception

Appendiceal intussusception is a rare entity. The majority of cases reported in the literature address surgical and colonoscopic approaches to treatment of the condition. The existing radiologic literature largely describes the sonographic and double-contrast enema findings of appendiceal intussusception. We present a case of appendiceal intussusception and describe the air-contrast enema, sonographic and CT findings.

Inflammatory chronic disease of the colon: How to image

Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Moreover, inflammatory bowel disease of the colon may be associated with complications, such as toxic megacolon, fulminant colitis, acute bleeding, fistulas and abscesses. Radiographic imaging studies are useful for the diagnosis of inflammatory bowel disease, and may be used to assess the extent and severity of disease, rule out complications, and monitor the response to therapy. The double-contrast barium study is a valuable technique for diagnosing inflammatory bowel disease colonic alterations, even in patients with early mucosal abnormalities. The earliest finding of UC is characterized by a fine granular appeareance of the colonic mucosa, usually involving the rectosigmoid junction. In chronic UC double-contrast enema may reveal marked colonic shortening with tubular narrowing of the bowel and loss of haustration. The earliest radiographics findings of Crohn's disease are represented by aphthous ulcers. As disease progresses, aphthous ulcers may enlarge and coalesce to form stellate or linear areas of ulceration. In advanced Crohn's disease, transmural ulceration may lead to the development of fissures, sinus tracts, fistulas, and abscesses. Cross sectional studies such as computed tomography, magnetic resonance imaging and sometimes ultrasound, are useful alternative tools not only in the assessment of bowel wall abnormalities, but also for the assessment of extraluminal alterations in patients with advanced disease.

Double contrast barium enema: Technique, indications, results and limitations of a conventional imaging methodology in the MDCT virtual endoscopy era

The double contrast barium enema of the colon continues to be a diffused conventional radiological technique and allows for the diagnosis of neoplastic and inflammatory pathology. After the ’70s, a massive initiative is undertaken to simplify, perfect and encode the method of the double contrast barium enema: Altaras from Germany, Miller from USA and Cittadini from Italy are responsible for the perfection of this technique in the last 30 years. The tailored patient preparation, a perfect technique of execution and a precise radiological documentation are essentials steps to obtain a reliable examination. The main limit of double contrast enema is that it considers the pathology only from the mucosal surface. In neoplastic pathology evaluation the main limit is the “T” parameter staging, but more limited are the “N” and “M” parameters evaluation. Today the double contrast technique continues to be a refined, sensitive and specific diagnostic method, moreover, diagnostic results cannot compete with the new CT multislice techniques (CT-enteroclysis and virtual colonoscopy) which can examine both the lumen and the wall of the colon. The double contrast is a cheap and simple examination but in the next future is predictably a progressive substitution of conventional radiology from new multislice techniques, because the cross sectional imaging is more frequently able to detect causes of the symptoms whether resulting both from colonic or non colonic origin.

Value of retesting subjects with a positive Hemoccult® in screening for colorectal cancer

Within a prospective randomized screening study for early detection of colorectal cancer with rehydrated Hemoccult II test, the possibility of increasing the specificity of the test by retesting patients with an initially positive Hemoccult II test was investigated. Of those offered the test 3561 (62.6 per cent) returned it and it was positive in 210 cases (5.9 per cent). The repeat test was performed by 184 patients and was positive in 68 (1.9 per cent). All those with a positive initial test had rectosigmoidoscopy to 60 cm and a double contrast enema. A carcinoma was found in one in seven patients with a positive retest but in only one in 100 patients with a negative retest (P less than 0.001). The specificity of the test was, therefore, increased from 95 per cent to 98 per cent and the sensitivity was unchanged. Rescreening was offered at a later date and increased numbers were available: 7147 patients returned the test and 369 (5.2 per cent) were positive. The test was repeated in 360 patients and 118 (1.7 per cent) were positive. A colorectal neoplasm was found in one in three of those with a positive repeat test, compared with one in seven of those with a negative repeat test. In conclusion, screening for early detection of colorectal cancer with a rehydrated Hemoccult II test may be followed by investigation of only those patients with a positive retest. Such a procedure will reduce the work-load by 60 per cent without reducing sensitivity.

Value of a risk questionnaire in screening for colorectal neoplasm.

The value of a postal questionnaire and of Hemoccult II (Smith Klein Diagnostic Inc., Sunnyvale, California, USA) testing in screening for colorectal neoplasms was compared. In the questionnaire, the subjects were asked about previous treatment for colorectal neoplasm and rectal bleeding during the previous 6 months, specified as to type. All participants were asked to perform Hemoccult II blood testing over 3 days. Of 13,759 randomly selected subjects 9040 (66 per cent) performed the test and returned the questionnaire. Three hundred and fifty-four subjects with a positive Hemoccult II test and/or a proven previous colorectal neoplasm had a full assessment including double-contrast enema and rectosigmoidoscopy to 60 cm. Eighteen carcinomas and 61 adenomas were thus diagnosed. The population was followed for from 20 to 29 months, during which time rescreening was undertaken. An additional 34 subjects with carcinomas and 90 with adenomas were identified during this period. A significant correlation between the presence of a colorectal neoplasm and a previous history of colorectal neoplasm, a positive Hemoccult II and a previous history of bright red bleeding but not dark bleeding was found. The possibility of diagnosing a neoplasm was two, four and 19 times higher in a subject with a previous history of bleeding, a history of colorectal neoplasm, or a positive Hemoccult II respectively. Screening by faecal occult blood testing, therefore, at the moment seems to be the best and only practicable method.

Book review

Illustrated Clinical Anatomy . By Peter Abrahams, John Craven and John Lumley . (Pp. 390 ; £25.00 paperback; illustrated; ISBN 0340807431 .) London : Hodder Arnold, 2005. ‘That is a good book which is opened with expectation and closed with profit.’ Amos Alcott (1799–1888) For centuries, students of medicine, dentistry and other allied health professions have been daunted by the challenge of learning human anatomy. Yet now, perhaps more than ever, the process of learning gross anatomy is becoming increasingly complex. For many of us, our anatomical education was through exploration. Hundreds of hours were spent with probe in one hand, worn dissection guide in the other, as we dutifully toiled over our cadavers and their secret parts. But today, across schools throughout the globe, there simply is neither the time nor often the resources to permit such a privilege. There is just too much information to be learned and too little time. I often laugh to myself when I hear the first-year medical students at our institution talking about sonic hedgehog signalling. The only signal I remember from medical school was the one the law students gave that told us to leave the library when we came in smelling of formaldehyde. This influx of new knowledge in the fields of immunology, developmental biology, genetics, biochemistry and pharmacology has, though necessary, limited the exposure students get to gross anatomy. Year-long courses have been shortened to weeks, dissections have often been replaced with the professional demonstration (the ‘prosaction’), and hands-on revision reduced to browsing a CD-ROM. Yet anatomy remains the bedrock of so much of what we do as healthcare providers and, as such, many students (and postgraduates for that matter) frequently find themselves searching for the Holy Grail of textbooks to provide a (1) readable, (2) appropriately detailed, (3) beautifully illustrated and (4) clinically relevant anatomy guide. From the moment I opened the cover of this book, my expectations were high. Written ‘by clinicians for clinicians’ the book is one of the few I have come across that meets the above criteria. It is organized into seven sections, including an overview of systems and organs and six parts of anatomy sectioned by region. One of the highlights of this book, and what makes it unique, is that it is also organized topographically, as this best relates to patient examination. The authors make the point that clinical examination of internal anatomy depends first on a knowledge of surface anatomy. One must know where to look, to know how to find, so to speak. To accomplish this, they have developed a comprehensive series of images with anatomical drawings of underlying structures superimposed over surface anatomy photographs. This is extremely useful for understanding complex anatomical regions that are often assessed by clinical examination, such as the knee joint. Many of these images can also be downloaded for personal use by the reader through a password-protected website listed on the front cover of the book. A second strength of this book is its incorporation of all modalities used to understand anatomy. There are several excellent radiographs, CT scans, MRIs, ultrasounds, and endoscopic and bronchoscopic images. These not only serve to illustrate anatomical pearls, but to show clinically relevant pathological findings as well. An excellent example of this is the image of the double contrast enema of the large bowel that beautifully illustrates bowel anatomy. This can then be compared with a similar image showing the classic ‘apple core’-shaped narrowing produced by carcinoma of the large bowel. Finally, each chapter concludes with several excellent self-examination questions. Like the illustrations, the questions use clinical scenarios to reinforce anatomical points. All things combined make this book one that is highly readable, appropriately detailed, beautifully illustrated and certainly clinically relevant. I would not recommend it as a dissection guide or single anatomical text as there is still great value in the classic illustrated works. However, it is an excellent reference for revision of clinically relevant human anatomy and suitable for all levels of experience. The book has brought the body back to anatomy, something from which the reader will surely profit.

Which colorectal cancers are missed by double contrast barium enema?

The relative merits of either barium enema or colonoscopy for investigating lower gastrointestinal tract symptoms is still unclear. We studied the value of double contrast barium enema (DCBE) as the initial evaluation modality. We reviewed our 10-year experience of double contrast enemas as read by consultant radiologists. The study also aimed to identify which lesions are usually missed. We reviewed clinical data for all patients who underwent DCBE within the 6 months prior to surgical resection of colorectal cancer between April 1989 and April 1999. Patient demographics and tumour characteristics were analysed for their effects on the likelihood of the lesions being missed at DCBE. There were 706 patients included in the study, 54.2% were male and the mean age was 63.7 years (SEM=0.5 years). The site along the colon and rectum of tumours missed by DCBE corresponded with the frequency of tumour occurrence at each site. The overall rate of missed lesions was 4.1% (29 of 706 patients); these patients were found on subsequent endoscopy to harbour cancer. Tumours less than 3 cm in length and with lesser extent of circumferential involvement were more likely missed at DCBE (p=0.05 and p=0.01, respectively). Age, sex, and tumour grade and stage were not significant predictors of the likelihood of missed lesions. Of the 29 patients with missed lesions, 77.2% had a serum concentration of carcinoembryonic antigen (CEA) above the normal range (3.5 microg/l). The mean follow-up was 65.3 months (SEM=1.8 months). The overall survival for this series was 60.1%. The inaccuracy of the initial DCBE was not found to cause statistically significant differences in the stage of the tumour at diagnosis nor the overall survival of the patients in our series. Smaller cancers without circumferential involvement may be missed when DCBE is performed to evaluate lower gastrointestinal symptoms. Further evaluation by colonoscopy must be recommended when symptoms persist, especially in the context of a raised CEA level.

P0590 ADENOMATOUS POLYPOSIS IN A NINE YEAR OLD BOY. A CASE REPORT

Introduction: According to Morisson’s histologic classification of epithelial polyps of the colon, adenomas are premalignant, which is of particular interest in cases with great abundance of adenomas, i.e. adenomatous polyposis. Unlike hamartomas, which are histologically more frequent in children, adenomas, particularly those located in the colon, are much less frequent. Methods: We report a case of adenomatous polyposis in a nine-year-old boy, who, had occasional, short lasting abdominal pain and small amounts of blood in the stool, from the age of four. These complaints were attributed to haemorrhoids. He also had sideropaenic anaemia treated with iron supplementation. Results: Two months prior to the admission to hospital, the abdominal pain started to occur daily and very frequently, accompanied with bloody stools. On admission, the boy was at the age of 9.5 yr. He had a “sick” look, with BW (10.p.), H (50.p.). Abdomen was distended, not sensitive on palpation. On rectal examination, numerous small polyps were palpated. Other physical examination was normal. Blood analysis showed sideropenic anaemia and trombocytosis, raised ESR rate and increased levels of fibrinogen and alpha2 and gamma globulins. Liver and kidney function tests were normal. On barium, double-contrast enema, multiple polyps and diverticulosis were seen along the colon (the highest distribution being in the left colon), causing dilations of the intestines and subsequent impaired innervations in all segments. Colonoscopy revealed hundreds of smooth-surface polyps of 0.7 cm approx. size. On histology, they were tubular adenomas, without dysplasia in all sections. Ultrasonography, esophagogastro-duodenoscopy and enteroclysis were performed and the findings excluded the possibility of neoplasms in other locations of the digestive tract. In order to determine the presence of a familial pattern, the parents of the patient were examined (abdominal ultrasound, barium enema and follow through of the small and large intestine). Since the results obtained were normal and excluded the presence of FAP, it was concluded that this was a case of a new mutation on the APC site of chromosome 5. A thorough genetic study was not possible. Conclusion: Surgery was recommended (total proctocolectomy with a jejunal patch), to which the parents consented three months later. The boy was well on forst follow-up.

Importance of double-contrast enema in the preoperative work-up for intestinal endometriosis

Importance of double-contrast enema in the preoperative work-up for intestinal endometriosis

Diverticulum-associated colon mass due to Mu ̈llerian cyst: Detection by barium enema but not colonoscopy

Gynecologic disease may present with GI symptoms or lesions. Intestinal obstruction due to advanced ovarian cancer and intestinal involvement by endometriosis have been well-documented. 1 Clarke-Pearson DL DeLong ER Chin N Rice R Creasman W. Intestinal obstruction in patients with ovarian cancer. Arch Surg. 1988; 123: 42-45 Crossref PubMed Scopus (35) Google Scholar , 2 Taal B Steinmetz R Den-Hartog-Jager F. Rectosigmoid obstruction caused by ovarian cancer. Clin Radiol. 1990; 41: 170-174 Abstract Full Text PDF PubMed Scopus (4) Google Scholar , 3 Krebs HB Goplerud DR. Mechanical intestinal obstruction in patients with gynecological disease: a review of 368 patients. Am J Obstet Gynecol. 1987; 157: 577-583 Abstract Full Text PDF PubMed Scopus (60) Google Scholar , 4 Bozdech JM. Endoscopic diagnosis of colonic endometriosis. Gastrointest Endoscopy. 1992; 38: 568-570 Abstract Full Text PDF PubMed Scopus (43) Google Scholar , 5 Shah M Tager D Feller E. Intestinal endometriosis masquerading as common digestive disorders. Arch Intern Med. 1995; 155: 977-980 Crossref PubMed Scopus (37) Google Scholar , 6 Willis TJ Pratt JH. Endometriosis in 1000 consecutive celiotomies: Incidence and management. Am J Obstet Gynecol. 1977; 129: 245-250 PubMed Google Scholar , 7 Weed JC Ray JE. Endometriosis of the bowel. Obstet Gynecol. 1987; 69: 727-730 PubMed Google Scholar , 8 Farinon AM Vadora E. Endometriosis of the colon and rectum: an indication for peroperative colonoscopy. Endoscopy. 1980; 12: 136-139 Crossref PubMed Scopus (17) Google Scholar , 9 Gordon RL Evers K Kressel HY Laufer I Herlinger H Thompson JJ. Double-contrast enema in pelvic endometriosis. AJR Am J Roentgenol. 1982; 138: 549-552 Crossref PubMed Scopus (42) Google Scholar Intestinal lesions or symptoms due to other benign gynecologic conditions are rare, but extrinsic mass effect from an enlarged uterus or ovary is sometimes seen in the colon. 10 Blackstone MO. Diverticular disease/sigmoid narrowing. in: Endoscopic Interpretation. : Raven Press, New York1984: 510-516 Google Scholar , 11 Wilcox CM. Colon. in: Atlas of clinical gastrointestinal endoscopy. : WB Saunders, Philadelphia1995: 207-276 Google Scholar , 12 Silverstein FE Tytgat GN. Colon II: diverticular disease, vascular malformations, and other colonic abnormalities. in: Atlas of gastrointestinal endoscopy. 2nd ed. : JB Lippincott, Philadelphia1991: 12.1-1217 Google Scholar Paratubal or Müllerian cysts of the fallopian tubes are thought to be derived from remnants of the embryologic Müllerian ducts. 13 Cotran RS Kumar V Tucker C. Fallopian tubes. in: Robbins pathological basis of disease. 6th ed. : WB Saunders, Philadelphia1999: 1065 Google Scholar , 14 Samaha M Woodruff JD. Paratubal cysts: frequency, histogenesis, and associated clinical features. Obstet Gynecol. 1985; 65: 691-694 PubMed Google Scholar , 15 Ritchie AC Female reproductive tract. in: 9th ed. Boyd's textbook of pathology. : Lea & Febiger, Philadelphia1990: 1294-1384 Google Scholar They may be as large as a few centimeters but are usually asymptomatic and of no clinical significance. Intestinal lesions due to paratubal or Müllerian cysts have not been previously reported.

Carbon dioxide or air in double-contrast enemas: a study of the pain and discomfort during and after examination

Carbon dioxide or air in double-contrast enemas: a study of the pain and discomfort during and after examination

Diffuse hemangioma of the colon

We report two cases of diffuse hemangioma of the colon in adolescent patients. One patient had multiple phleboliths at the lower pelvis identified with plain radiographs of the abdomen. Several aspects were seen on double-contrast enema: luminal narrowing, colonic-wall thickening and submucosal colonic masses that changed in appearance with the degree of colonic distension. Angiography was inconclusive in one case. Use of CT and MR provided relevant information regarding the true extent of the disease, but MR was superior in demonstrating unequivocally the vascular nature of the lesions.

Carbon dioxide or air in double-contrast enemas: a study of the pain and discomfort during and after examination

This prospective randomized double-blind study was done to assess the difference between carbon dioxide (CO2) and air regarding pain and discomfort during and after double-contrast enemas, and to find a possible explanation of why prior investigations have come to different conclusions regarding the usefulness of CO2. Using a questionnaire opinions regarding pain and discomfort during and 30 mins, 2 h and 8 h after a double-contrast enema with either CO2 or air were collected from 142 and 120 patients, respectively. The study has shown less pain and discomfort 30 min and 2 h after the enema when CO2 was used, whereas there is no significant difference during the examinations and after 8 h. Together with the fact that there are patients reporting worsening pain after the exam, this might explain the differences between earlier investigations. Because CO2 gives less pain than air it is recommended as a negative contrast medium in double-contrast enemas, although the distension of the bowel is not as good as with air.

A CASE OF CROHN'S DISEASE CAUSING PERFORATED PERITONITIS

This paper presents a case of Crohn's disease causing perforated peritonitis which required emergency operation. A 27-year-old man had loose stool since the age of ten. From he was 20 years old on, abdominal pain, diarrhea, and fever developed several times a year which had been treated by nearby family doctor. At the age of 24, he was diagnosed as Crohn's disease mainly occupying the terminal ileum, with barium enema, double contrast enema of the small intestine and endoscopic biopsy. Protein loosing from the terminal ileum was also detected by RI-image. The patient was conservatively treated with salazopyrin, and steroid. On March 1, 1991, he was admitted to the hospital because of severe abdominal pain and vomiting, and was diagnosed as ileus by stenosis of the ileum which was caused by Crohn's disease. Serum protein was 4.8g/dl. On March 11, he suddenly developed a severe abdominal pain and emergency operation was performed under a diagnosis of panperitonitis. It was found that panperitonitis was caused by perforation in the terminal ileum. Right hemicolectomy including the perforated lesion was performed. The stomas were made from both resected ends. postoperative course uneventful and hypoproteinemia was normalized. Five months later, closure of the stomas was carried out.

The anatomic range of examination by fibreoptic rectosigmoidoscopy (60 centimetres).

The purpose of the study was to investigate the anatomic location of the flexible rectosigmoidoscope (60 cm) when introduced as far as technically possible. One hundred and forty-nine consecutive patients referred for double-contrast enema (DCE) were examined with rectosigmoidoscopy before the radiologic examination, and CO2 was used for insufflation. A plain abdominal film was taken to locate the tip of the instrument when 60 cm or as much as possible of the instrument had been introduced. The sigmoid loop was passed and the tip of the scope located in the ascending colon or at the left flexure in 99 (66%) of the patients, and in a further 27 (18%) the upper part of the sigmoid colon was reached. The sigmoid colon had been passed in 71%, 80%, and 44% when 60, 50, and 40 cm of the instrument was introduced, respectively. DCE could be performed at the same session as the rectosigmoidoscopy, as CO2 was quickly absorbed. In the vast majority of patients the sigmoid colon can be inspected with a rectosigmoidoscope.

Effects of Local Ischemia and Bacterial Flora on Healing of Experimental Colonic Anastomoses

In the present study the effects of local bowel perfusion on anastomotic healing of experimental colonic anastomoses were evaluated in 54 female chinchilla rabbits. Local ischemia was induced by devascularization of the sigmoid colon. Animals were randomly allocated to 4 operative groups. In the animals of group 1 a colo-colonic anastomosis was performed in an area graded as ischemia grade A (intact perfusion). Animals of group 2 received a colo-colonic anastomosis in the sigmoid colon segment, graded as ischemia grade B (marginal perfusion). Group 3 received pretreatment with neomycin and was otherwise treated like group 2. Animals of group 4 a colo-colonic anastomosis was performed in the ischemia grade-C region (total ischemia). The rate of anastomotic leakage was monitored by periodic double contrast enemas. The experiment was terminated on the 8th postoperative day, and microangiography to assess revascularization was performed followed by assessment of perianastomotic adhesions. The rate of anastomotic failure as well as the occurrence of anastomotic failure over time highly depended on the severity of ischemia. Bowel sterilization by neomycin significantly reduced the rate of anastomotic leakage. The development of perianastomotic adhesions correlated with the severity of ischemia. Microangiography suggested that revascularization originated in the perianastomotic adhesions.

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The double-contrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.