Intestinal X-rays

X-ray examination is a traditional method of studying the small and large intestines. There are numerous indications for it. In emergency medical care, this is a suspicion of intestinal obstruction, intestinal perforation, thromboembolism of the mesenteric vessels, gastrointestinal bleeding. In routine clinical practice, the indications are abdominal pain, changes in the frequency and nature of stool, unexplained anemia, searches for a hidden cancer process, signs of gastrointestinal bleeding, the source of which is not found in either the esophagus or the stomach.

On conventional radiographs, the outlines of intestinal loops are poorly distinguishable; only gas accumulations and shadows of formed fecal masses in the distal parts of the colon and in the rectum are visible. In this regard, survey radiographs are used primarily in the diagnosis of acute intestinal obstruction. The leading method of radiological examination is artificial contrasting - the introduction of a contrast agent into the intestinal lumen.

Each section of the intestine is examined with varying degrees of filling with contrast mass and with different positions of the patient's body. Low filling allows for a detailed assessment of the relief of the inner surface of the intestine, the folds of its mucous membrane. In combination with inflation of the intestine with air, it provides plastic images of the walls and inner surface of the intestine. Massive (tight) filling allows for determining the position, shape, size, outline, displacement and function of the organ. In the course of the examination, overview and targeted radiographs are combined. In recent years, computed tomography and ultrasound examination of the intestine have become increasingly important.

Normal small intestine

The most physiological method of artificial contrasting of the small intestine is oral contrasting, achieved by taking an aqueous suspension of barium sulfate orally. After passing the stomach and duodenum, the contrast mass enters the jejunum and then the ileum. 10-15 minutes after taking the barium, the shadow of the first loops of the jejunum is determined, and after 1-2 hours - the remaining sections of the small intestine.

Normal colon and rectum

Conventional images do not provide a clear image of the colon and rectum. If images are taken after the patient has taken an aqueous suspension of barium sulfate orally, the passage of the contrast mass through the digestive tract can be recorded. From the terminal loop of the ileum, the barium passes into the cecum and then sequentially moves to the remaining sections of the colon. This method, the "contrast breakfast" method, is used only to assess the motor function of the colon, but not to study its morphology. The fact is that the contrast contents are distributed unevenly in the intestine, mixed with food waste, and the relief of the mucous membrane is not displayed at all.

The main radiological method for examining the colon and rectum is their retrograde filling with a contrast mass - irrigoscopy.

In this examination, careful preparation of the patient is very important: a low-residue diet for 2-3 days, taking laxatives - one tablespoon of castor oil at lunch the day before, a series of cleansing enemas - the evening before and early in the morning on the day of the examination. Some radiologists prefer preparation with special tablets, such as contact laxants, which promote the rejection of feces from the intestinal mucosa, as well as the use of laxative suppositories and magnesium sulfate.

Bowel diseases

Recognition of bowel diseases is based on clinical, radiological, endoscopic and laboratory data. Colonoscopy with biopsy plays an increasingly important role in this complex, especially in the diagnosis of early stages of inflammatory and tumor processes.

Acute mechanical intestinal obstruction. Radiographic examination is of great importance in its recognition. The patient is in an upright position and undergoes general radiographs of the abdominal organs. Obstruction is indicated by swelling of the intestinal loops located above the site of obstruction or compression of the intestine. Gas accumulations and horizontal fluid levels (the so-called Kloiber cups or levels) are determined in these loops. All intestinal loops distal to the site of obstruction are in a collapsed state and do not contain gas or fluid. It is this sign - collapse of the poststenotic segment of the intestine - that allows us to distinguish mechanical intestinal obstruction from dynamic (in particular, from paresis of the intestinal loops). In addition, with dynamic paralytic obstruction, peristalsis of the intestinal loops is not observed. Fluoroscopy does not reveal the movement of contents in the intestine and fluctuations in fluid levels. With mechanical obstruction, on the contrary, repeated images never copy those taken earlier, the picture of the intestine is constantly changing.

Appendicitis.

The clinical signs of acute appendicitis are known to every doctor. Radiological examination serves as a valuable method of confirming the diagnosis and is especially indicated in cases of deviation from the typical course of the disease. The examination tactics are presented in the form of the following diagram.

Intestinal dyskinesin. X-ray examination is a simple and accessible method for specifying the nature of the movement of contents through the loops of the small and large intestine and diagnosing various types of constipation.

Enterocolitis. Similar symptoms are observed in acute enterocolitis of various etiologies. Small gas bubbles with short liquid levels appear in the intestinal loops. The movement of the contrast agent is uneven, with separate accumulations of it observed, with constrictions between them. The folds of the mucous membrane are thickened or not differentiated at all. All chronic enterocolitis accompanied by malabsorption syndrome are characterized by common signs: dilation of the intestinal loops, accumulation of gas and liquid in them (hypersecretion), separation of the contrast mass into separate lumps (sedimentation and fragmentation of the contents). The passage of the contrast agent is slow. It is distributed unevenly over the inner surface of the intestine, small ulcers may be visible.

Malabsorption. It is a disorder of absorption of various components of food. The most common diseases are those of the sprue group. Two of them - celiac disease and non-tropical sprue - are congenital, and tropical sprue is acquired. Regardless of the nature and type of malabsorption, the X-ray picture is more or less the same: dilation of the loops of the small intestine is determined. Liquid and mucus accumulate in them. Because of this, the barium suspension becomes heterogeneous, flocculates, divides into fragments, and turns into flakes. The folds of the mucous membrane become flat and longitudinal. A radionuclide study with trioleate-glycerol and oleic acid establishes a violation of absorption in the intestine.

Regional enteritis and granulomatous colitis (Crohn's disease). In these diseases, any part of the digestive tract can be affected - from the esophagus to the rectum. However, the most common lesions are those of the distal jejunum and proximal ileum (jejunoileitis), terminal ileum (terminal ileitis), and proximal colon.

Tuberculosis of the intestine. The ileocecal angle is most often affected, but examination of the small intestine already reveals thickening of the mucous membrane folds, small accumulations of gas and fluid, and slow movement of the contrast mass. In the affected area, the intestinal contours are uneven, the mucous membrane folds are replaced by infiltration areas, sometimes with ulcerations, and there is no haustration. It is curious that the contrast mass does not linger in the infiltration zone, but quickly moves on (a symptom of local hyperkinesia). Subsequently, the intestinal loop shrinks with a decrease in its lumen and limited mobility due to adhesions.

Non-specific ulcerative colitis. Mild forms are characterized by thickening of the mucosal folds, point accumulations of barium, and fine serration of the intestinal contours as a result of the formation of erosions and small ulcers. Severe forms are characterized by narrowing and rigidity of the affected sections of the colon. They stretch little and do not expand with retrograde administration of a contrast mass. Haustration disappears, the intestinal contours become finely serrated. Instead of folds of the mucosa, granulations and accumulations of barium in ulcers appear. The distal half of the colon and the rectum are predominantly affected, which are sharply narrowed in this disease.

Colon cancer. Cancer appears as a small thickening of the mucous membrane, a plaque, or a polyp-like flat formation. Radiographs show a marginal or central filling defect in the shadow of a contrast mass. The folds of the mucous membrane in the defect area are infiltrated or absent, peristalsis is interrupted. As a result of tumor tissue necrosis, an irregularly shaped barium depot may appear in the defect - a reflection of ulcerated cancer. As the tumor grows further, two types of radiographic images are mainly observed. In the first case, a tuberous formation protruding into the intestinal lumen (exophytic growth type) is revealed. The filling defect has an irregular shape and uneven contours. The folds of the mucous membrane are destroyed. In the second case, the tumor infiltrates the intestinal wall, leading to its gradual narrowing. The affected section turns into a rigid tube with uneven contours (endophytic growth type). Sonography, AT, and MRI help to clarify the degree of invasion of the intestinal wall and adjacent structures. In particular, endorectal sonography is valuable in rectal cancer. CT scans make it possible to assess the condition of the lymph nodes in the abdominal cavity.

Benign tumors.

About 95% of benign intestinal neoplasms are epithelial tumors - polyps. They can be single or multiple. The most common are adenomatous polyps. They are small, usually no more than 1-2 cm in size, growths of glandular tissue, often have a stalk (stem). In X-ray examination, these polyps cause filling defects in the intestinal shadow, and with double contrast - additional rounded shadows with even and smooth edges.

Acute abdomen. The causes of acute abdomen syndrome are varied. For an urgent and accurate diagnosis, anamnestic information, clinical examination results and laboratory tests are important. X-ray examination is used when it is necessary to clarify the diagnosis. As a rule, it begins with chest X-ray, since acute abdomen syndrome can be a consequence of pain irradiation due to lung and pleural damage (acute pneumonia, spontaneous pneumothorax, supradiaphragmatic pleurisy).