Normal X-ray anatomy of the stomach and duodenum

Before receiving contrast mass in the stomach, there is a small amount of air. With the vertical position of the body, the gas bubble is located in the region of the arch. The rest of the stomach is a roller with thick and maximally close walls.

The contrast mass swallowed by the patient, with the vertical position of the body, gradually passes from the esophagus into the stomach and descends from the cardial opening into the body, the sinus and the antral compartment. After the first small sips of barium, the folds of the mucous membrane of the stomach appear - a relief appears on the inner surface of the organ. This folded relief is unstable and reflects the physiological state of the stomach.

In the vault area, various variants of the folding process are observed; usually long and arc-shaped folds are combined here with transversely and obliquely running. In the body of the stomach, 3-4 longitudinal slightly sinuous folds are defined. The outgoing part of the stomach is dominated by obliquely and longitudinally extending folds. They converge to the doorkeeper, continue in his canal and in the bulb of the duodenum. However, beginning with the upper inflection of the duodenum, the relief of the mucous membrane changes sharply: transverse and obliquely arranged short folds appear. Only at the time of passing the peristaltic wave do they take the longitudinal direction.

As the stomach is inflated with air, the shape and thickness of the folds change and eventually they disappear. In the pictures appears an image of a peculiar cellular pattern - a delicate relief of the inner surface of the wood. It is formed by oval and round elevations of 2-3 mm - areoles, or gastric fields. The subtle relief differs from folded by its constancy.

After receiving the whole contrast mass, the stomach becomes a hook in the vertical position of the body. In it, the main departments are distinguished: the vault, the body, the sinus, the antral department and the gatekeeper. The area around the cardiac opening is called the cardial part (in it supra- and sub-cardial divisions are isolated). A place on a small curvature, where the body of the stomach passes into its outlet, is called the angle of the stomach. A small part of the antral section in front of the gatekeeper - a length of 2-3 cm - is called the pre-surgeon's (prepyloric) department. The canal of the gatekeeper is only visible when the barium passes through it.

In the duodenum, the upper, descending and horizontal (lower) parts and the three bends are distinguished: upper, lower and duodenum-thin. In the upper part of the intestine, an ampoule is isolated, or, according to roentgenological terminology, an onion. In the bulb distinguish two pockets - the medial and lateral. In the descending part of the intestine it is possible to reveal an oval elevation-a large papilla-the place of the common bile duct and the duct of the pancreas (the virsung duct). Sometimes the ducts flow into the gut on their own. In such cases, roentgenologically sometimes it is possible to find the second oval elevation - a small papilla of the duodenum.

The manifestations of the muscular activity of the stomach are its contraction and relaxation, which can be fixed in a series of images, as well as peristaltic waves that follow from the cardia to the doorman at an interval of about 20 s. The total duration of the wave travels along this distance is about 20 s; 200 ml of barium aqueous suspension leave the stomach for 1> / 2-3 hours. The food is delayed in the stomach much longer.

More accurate data on the evacuation of contents from the stomach allows us to obtain dynamic scintigraphy. On an empty stomach the patient is offered a breakfast with a total mass of 500 g. Its standard composition is 10% semolina, tea with sugar, a piece of stale white bread. In this breakfast, 99mTc-colloid is injected with activity of 10-20 MBq. Scintigraphy begins immediately after the end of food intake (in the vertical position) and is repeated with a pre-selected periodicity for 90 minutes. Then a computer analysis of a series of scintigrams of the stomach is carried out, a resultant curve is constructed, which determines the period of semi-emptying of the stomach from a standard breakfast. In healthy people, its duration is an average of 45 minutes.

The mucous membrane of the stomach is able to extract from the blood and accumulate 99mTc-pertechnetate. After its intravenous administration, a "hot zone" corresponding to the location of the stomach appears on the scintigrams. This property is used to identify areas of the ectopic mucosa of the stomach. Most often, its islets meet in the esophagus (the so-called Berretian esophagus) or in the diverticulum of the ileum (mecca diverticulum), located in its distal part. In the esophagus, this pathology can be complicated by inflammation and development of peptic ulcer, and in Meckel diverticulum - diverticulitis and bleeding (these complications are more common in children of the first 2 years of life). To reveal the ectopic mucosa, 10 MBq of 99mTc pertechnetate is injected into the vein. When it is localized in the Meckelian diverticulum on the scintigram, you can see the RFP accumulation zone in the right ileal region.

[1], [2], [3]