Prone compression with the pneumatic paddle during barium studies

The role of small bowel radiology in the diagnosis and management of Crohn's disease

A total of 50 children with Crohn's disease were examined by barium follow-through and colonoscopy with ileoscopy, to determine the value of small bowel radiology. Of these children, 40 (80%) had evidence of small bowel Crohn's disease on ileoscopy and/or barium follow-through. Twenty-two (44%) had disease confined to the terminal ileum. Radiology diagnosed disease proximal to the terminal ileum in 18 cases (36%), including 5 children in whom the terminal ileum was normal. Ileoscopy was not possible in nine patients (18%), six of whom had small bowel disease on barium follow-through. Colonic involvement, demonstrated in 34 (68%), was the sole site of disease in 6 (12%). Fifteen (30%) children had surgery, which in six (12%) was determined by the radiological findings of complicated small bowel disease. As the terminal ileum may be uninvolved in the presence of proximal ileal disease, normal ileoscopy does not exclude small bowel Crohn's disease. Small bowel radiology remains necessary to assess the full extent of Crohn's disease in children.

The distribution of small bowel Crohn's disease in children compared to adults

Barium follow-through (BaFT) examinations in 67 children and 114 adults with proven Crohn's disease (CD) were reviewed. Forty-six (68.7%) children and 62 (54.4%) adults had evidence of small bowel CD on BaFT. The frequency of CD in the proximal, mid and distal small bowel was 30.4%, 45.7% and 80.4%, respectively for children and 14.5%, 59.7% and 93.5% for adults. Children had significantly more duodenal/jejunal disease than adults (chi 2 = 3.99, P < 0.05) and significantly less terminal ileal disease (chi 2 = 4.29, P < 0.05). There was no significant difference in mid ileal disease. Nine (19.6%) children had small bowel CD with a normal terminal ileum compared with four (6.5%) adults. Ileoscopy-negative children have more proximal small bowel CD than adults and less distal disease. BaFT examination is essential if small bowel CD is not to be missed in children.

Benefit of intravenous muscle relaxants during barium follow through

The value of an intravenous (i.v.) smooth muscle relaxant during barium follow through (BaFT) examination has been evaluated in a prospective study of 51 patients. Spot compression films pre- and post-relaxant were compared. Relaxant-induced hypotonia improved image quality in 33 (64.8%) patients by facilitating bowel loop separation and/or graded compression. Additional diagnostic information was obtained in 14 (27.5%), and reporting confidence was improved in 19 (37.3%) patients. A marked analgesic effect occurred in seven patients with Crohn's disease, ameliorating pain that otherwise prevented full compression. Intravenous relaxants are recommended when high tone makes compression difficult, to help separate overlying loops and where pain in Crohn's disease prevents adequate compression.

Radiological investigation of chronic inflammatory bowel disease in childhood

The radiological investigations relevant to chronic IBD are described briefly with emphasis placed on compression techniques in small bowel studies. A classification for reporting small bowel Crohn's disease is proposed, where the disease is staged as early, advanced or complicated, and the extent of involvement measured directly from the film. The terminal ileum may be normal in 20% of children with proximal Crohn's disease, so that ileoscopy should not be used to exclude small bowel disease. Radiological assessment of the small bowel is important in management. Surgical referral was based on the radiological changes in 6% of patients, and in 24% the presence of extensive uncomplicated small bowel Crohn's disease led to treatment with elemental diet. The use of some specialized examinations, such as the instant and ileostomy enema, are discussed.

Case report: persistent colonic spasm concealing a carcinoma--an uncommon diagnostic pitfall of the barium enema examination

Colonic carcinomas may be missed on the barium enema examination for a variety of perceptive, technical, and interpretive reasons. We report an uncommon source of error-persistent bowel spasm resulting in concealment of an underlying carcinoma. Awareness of this association is necessary in the effort to minimize diagnostic pitfalls of the barium enema examination.

Modifications to the gas-enhanced small bowel barium follow-through using gastrografin and compression

The transit time of barium through the small bowel has been assessed in two groups of patients. In 52 patients who were given 300 ml 50% w/v baritop and effervescent tablets, the mean transit time was 78.4 min. In 61 patients who were given 300 ml 100% w/v baritop to which 10 ml of Gastrografin had been added, and who were also given effervescent tablets, the mean transit time was 60.2 min. This difference is highly significant (P less than 0.001). It is suggested that small quantities of Gastrografin act as an accelerator of barium transit by causing the release of serotonin (5-hydroxytryptamine) from the small intestinal mucosa. We believe that the distension of the small bowel lumen achieved by the administration of effervescent tablets improves the quality of the small bowel follow-through examination and also improves its accuracy particularly in the diagnosis of Crohn's disease and small bowel adhesions. The importance of performing the whole examination under fluoroscopic control and the value of compression films is stressed.