X-ray of the intestine

Radiography is a traditional method of studying the small and large intestine. Indications for him are numerous. In conditions of emergency medical care - this is a suspicion of intestinal obstruction, perforation of the intestine, thromboembolism of mesenteric vessels, gastrointestinal bleeding. In normal clinical practice, indications are abdominal pain, changes in the frequency and character of the stool, unexplained anemia, the search for a hidden cancer process, signs of gastrointestinal bleeding, the source of which is not found in the esophagus or in the stomach.

On usual roentgenograms, the outlines of the intestinal loops are poorly discernible, 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, overview radiographs are used primarily in the diagnosis of acute intestinal obstruction. The leading method of X-ray examination is artificial contrasting - the introduction of a contrast agent into the lumen of the intestine.

Each section of the intestine is examined at different degrees of filling with contrast mass and with different positions of the patient's body. Small filling gives an opportunity to assess in detail the relief of the inner surface of the intestine, the folds of its mucous membrane. In combination with bloating the gut with air, it provides a plastic picture of the walls and the inner surface of the gut. Massive (tight) filling allows you to determine the position, shape, size, outlines, displacement and function of the organ. In the course of the study, survey and sighting 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 inside. Passing the stomach and duodenum, the contrast mass enters the skinny and then into the ileum. After 10-15 minutes after taking barium, the shadow of the first loops of the jejunum is determined, and in 1-2 hours the remaining parts of the small intestine are determined. 

Normal thick and rectum

In normal pictures, there is no clear image of the colon and rectum. If you take pictures after taking the patient's aqueous suspension of barium sulfate inside, you can register a passage of contrast mass through the digestive canal. From the terminal loop of the ileum, the barium passes into the cecum and then subsequently moves to the remaining parts of the large intestine. This method - the method of "contrasting breakfast" - is used only to assess the motor function of the colon, but not to study its morphology. The fact is that the contrast content is distributed unevenly in the intestine, mixed with food slags, and the mucosal relief is not displayed at all.

The main ray method of investigation of the colon and rectum is their retrograde filling with contrasting mass - irrigo-scopia.

In this study, careful preparation of the patient is very important: a slag-free diet for 2-3 days, intake of laxatives - one tablespoon of castor oil for dinner on the eve, a series of cleansing enemas - the night before and early in the morning on the day of the study. Some radiologists prefer the preparation with the help of special tablets, for example, contact laxatives, which promote the rejection of fecal matter from the intestinal mucosa, as well as the use of laxative suppositories and magnesium sulfate.

Diseases of the intestine

The recognition of bowel diseases is based on clinical, radiological, endoscopic and laboratory data. A growing role in this complex is played by a colonoscopy with biopsy, especially in the diagnosis of early stages of inflammatory and tumor processes.

Acute mechanical obstruction of the intestine. In its recognition, radiology is of great importance. The patient in an upright position produces an overview of the chest radiographs of the abdominal organs. The obstruction is indicated by the swelling of the intestinal loops located above the site of obstruction or compression of the intestine. In these loops, gas accumulations and horizontal liquid levels are determined (the so-called bowls, or levels, of Clauber). All loops of the intestine distal to the occlusion site are in a collapsed state and do not contain gas and liquid. It is this symptom - the collapse of the poststenotic segment of the intestine - that makes it possible to distinguish between mechanical obstruction of the intestine and the dynamic (in particular, from the paresis of the intestinal loops). In addition, with dynamic paralytic obstruction there is no peristalsis of intestinal loops. When fluoroscopy can not detect the movement of contents in the gut and fluctuations in fluid levels. With mechanical obstruction, on the contrary, repeated pictures never copy previously made, the picture of the intestine changes all the time.

Appendicitis.

Clinical signs of acute appendicitis are known to every doctor. Radiation examination serves as a valuable way to confirm the diagnosis and is especially indicated for deviations from the typical course of the disease. The survey tactics are presented as the following scheme.

Dyskinesin of the intestine. X-ray examination is a simple and accessible method of clarifying the nature of the content flow through the loops of the small and large intestine and diagnosing various variants of constipation (constipation).

Enterocolitis. With acute enterocolitis of different etiology, there are similar symptoms. Small bubbles of gas with short liquid levels appear in the intestinal loops. The progress of the contrast medium is uneven, there are separate clusters of it, between which there are constrictions. The folds of the mucosa are thickened or not at all differentiated. For all chronic enterocolitis, accompanied by a syndrome of malabsorption, characteristic features are common: the expansion of the intestinal loops, the accumulation of gas and liquid in them (hypersecretion), the separation of the contrast mass into separate lumps (sedimentation and fragmentation of the contents). Passage of contrast medium is slowed down. It is distributed unevenly over the inner surface of the intestine, small ulceration can be seen.

Malabsorption. With it, the absorption of various constituents of food is impaired. The most common are the diseases of the sprue group. Two of them - celiac disease and non-tropical sprue - belong to the congenital, and tropical sprue - to the acquired. Regardless of the nature and type of malabsorption, the X-ray picture is more or less the same: the expansion of the small intestine loops is determined. They accumulate liquid and mucus. Barium suspension because of this becomes non-uniform, flocculates, is divided into fragments, turns into flakes. The folds of the mucosa become flat and longitudinal. In a radionuclide study with trioleate-glycerin and oleic acid, a violation of absorption in the intestine is established.

Regional enteritis and granulomatous colitis (Crohn's disease). With these diseases, any part of the digestive canal can be affected - from the esophagus to the rectum. However, the most common lesions are the distal part of the jejunum and the proximal part of the iliac (ileoileitis), terminal iliac (terminal ileitis), proximal parts of the large intestine.

Tuberculosis of the intestine. The ileocecal angle is most often affected, but already in the study of the small intestine, there is a thickening of the folds of the mucous membrane, small accumulations of gas and liquid, slow progress of contrast mass. In the region of the lesion, the intestinal contours are uneven, the folds of the mucous membrane are replaced by infiltration sites, sometimes with ulceration, and there is no gaustration. It is curious that the contrast mass in the infiltration zone is not delayed, but quickly moves further (a symptom of local hyperkinesia). Later, the intestinal loop wrinkles with a decrease in its lumen and restriction of dislocation due to adhesions.

Nonspecific ulcerative colitis. With mild forms, there is a thickening of the folds of the mucous membrane, point accumulations of barium and small dentition of the gut contours as a result of the formation of erosions and small ulcers. Heavy forms are characterized by constriction and stiffness of the affected parts of the colon. They are slightly stretched, do not expand with retrograde insertion of contrast mass. Gausstration disappears, the contours of the intestine are made small-serrated. Instead of folds of the mucous membrane, granulations and accumulations of barium in ulceration appear. Primarily affects the distal half of the large intestine and rectum, which in this disease is sharply narrowed.

Bowel cancer. Cancer occurs in the form of a small thickening of the mucosa, a plaque or a poly-like flat formation. On the radiographs, the marginal or central defect of filling in the shadow of the contrast mass is determined. The folds of the mucosa in the area of the defect are infiltrated or absent, the peristalsis is interrupted. As a result of necrosis of the tumor tissue in the defect, a barium depot of irregular shape may appear - a display of ulcerated cancer. As the tumor grows further, two variants of the radiographic pattern are observed. In the first case, a tuberous formation appears, which penetrates into the lumen of the intestine (exophytic type of growth). 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 department turns into a rigid tube with uneven outlines (endophytic type of growth). Sonography, AT and MRI allow us to clarify the degree of invasion of the intestinal wall and adjacent structures. In particular, endorectal sonography is valuable in cancer of the rectum. Computer tomograms make it possible to assess the state of the lymph nodes in the abdominal cavity.

Benign tumors.

About 95% of benign neoplasms of the intestine are epithelial tumors - polyps. They are single and multiple. The most common adenomatous polyps. They are small, usually not larger than 1-2 cm, overgrowth of glandular tissue, often have a stem (stem). In the X-ray study, these polyps cause filling defects in the shade of the intestine, and with double contrasting, additional rounded shadows with smooth and smooth edges.

Sharp abdomen. The causes of the syndrome of an acute abdomen are diverse. To establish an urgent and accurate diagnosis, anamnestic information, the results of clinical examination and laboratory tests are important. To radiation study resorted to the need to clarify the diagnosis. As a rule, it begins with the radiography of the chest cavity, since the syndrome of the acute abdomen can be a consequence of the irradiation of pain in the lungs and pleura (acute pneumonia, spontaneous pneumothorax, diaphragmatic pleurisy).