[Contribution of radiology to the postoperative after care of patients with colorectal tumors]

The prognosis of local recurrences after surgery for colorectal cancer is better than in recurrences of many other tumor sites. Since in most cases secondary tumor growth takes place as local recurrence and distant metastases are infrequent, there is a good chance of detecting the recurrence early in a curable state. This offers good conditions for a radical second operation. Following excision of tumors, double-contrast enema permits a very detailed assessment of the anastomosis, allowing detection of small local recurrences and recognition of postoperative changes or sequelae of delayed healing at the site of the anastomosis. Following amputation of the rectum, computed tomography permits better control of the presacral space than other conventional radiodiagnostic procedures. In both situations, however, integration of both methods is necessary in a consequent time schedule of clinical follow-up with suitable intervals.

Double contrast enema and colonoscopy in polyp detection

The diagnostic accuracy of double contrast enema was assessed by colonoscopy of 250 consecutive patients with polypoid lesions that were observed at double contrast enema. The enema method detected 90% of all existing polypoid lesions, and gave false positive results in less than 3.5% Colonoscopy revealed 91% of the lesions. Double contrast enema is suitable as a screening procedure and, when used in combination with colonoscopy, only very few polyps will escape detection. The large number of neoplastic polyps detected in this retrospective series emphasises the necessity for a careful radiographic technique combined with colonoscopy to disclose and treat these potentially malignant lesions of the colon.

[Mucosal relief patterns in the colon (author's transl)]

Various types of mucosal relief patterns in the colon were classified on the basis of 270 double contrast examinations. Ten patterns were distinguished. In about 60% of examinations a normal pattern could be recognised, consisting of fine linear or reticular shadows. All other patterns depend on a substrate of morphological changes, which may result from surgical anastomoses, from stenoses or from inflammatory changes.

Ulcerative colitis and a bleeding polyp detected on Tc-99m-pertechnetate abdominal scintigraphy

Two children with rectal bleeding were diagnosed as having ulcerative colitis and a bleeding colonic polyp respectively using abdominal scanning with Tc-99m pertechnetate. Early flow studies are recommended with careful attention paid to the amount of time abnormal areas of activity are seen on the abdominal scan.

The radiographic appearance of the stomach in Cronkhite-Canada syndrome

Cronkhite-Canada syndrome is a nonfamilial form of diffuse gastrointestinal polyposis associated with ectodermal abnormalities of alopecia, and hyperpigmentation. Recent experience with two patients in whom the diagnosis was pathologically confirmed suggest that there is a specific radiographic appearance to the stomach in this disorder. There are enlarged rugal folds, polyps, and "whiskering" (appearance of multiple tiny projections due to barium trapped between nodular excrescences of rugae). When accompanied by the characteristic ectodermal abnormalities, this radiographic pattern aids in the diagnosis of this complex clinical entity.

Giant pseudopolyps in Crohn's colitis. A nonoperative approach

Six patients with Crohn's disease had colonic intraluminal multilobulated masses detected on barium enema. Four had Crohn's colitis and two ileocolitis. The mean duration of disease was four and eight tenths years. Three patients underwent surgery and three had colonoscopy with multiple biopsies and cytology. Pseudopolypoid inflammatory tissue was found in each case. One patient died after a prolonged postoperative course due to sepsis and abscess formation. No surgery was performed in three patients and follow-up colonoscopic examinations at four and a half years revealed no change in these findings. The presence of an intraluminal colonic mass in Crohn's colitis may mimic a neoplasm. If surveillance with x-ray, endoscopic biopsies and cytology reveals pseudopolypoid inflammatory tissue then surgery is not mandatory. Pseudopolypoid inflammatory tissue has never been associated with carcinoma.

Single- vs. double-contrast gastrointestinal studies: critical analysis of reported statistics

A literature review of Western publications for the reported sensitivities of single- and double-contrast gastrointestinal examinations indications that certain claims of superiority for the double-contrast technique may be optimistically misleading. Analysis of reports on detection of four entities-gastric cancer, gastric ulcer, duodenal ulcer, and colonic polyps-suggests superiority for the double-contrast barium enema for detection of colonic polyps. However, no advantage for single- or double contrast examinations was demonstrable for the detection of gastric cancer, gastric ulcer, or duodenal ulcer.

The role of sigmoidoscopy, radiographs, and colonoscopy in the diagnostic evaluation of pediatric age patients with suspected juvenile polyps

Juvenile polyps are the most common cause of painless hematochezia in pediatric Age patients after the first year of life. This study evaluated the role of rigid proctosigmoidoscopy, air contrast barium enema examinations, and colonoscopy in the diagnostic approach to 43 such patients. During sigmoidoscopy, polyps were removed from 31 children. On subsequent barium enema examination, more proximal lesions were found in only 4 of these 31 patients, but were seen in 7 of the 12 children who had negative sigmoidoscopic evaluations. Fourteen children had colonoscopy performed. This group included the latter 12 patients plus 2 of the former 4 who again developed hematochezia. Polypectomies were done during 11 of these procedures. Eight of these 11 children had proximal lesions seen during radiographic studies. The diagnostic approach to pediatric age patients with painless hematochezia should include an initial rigid sigmoidoscopic examination. Barium enema evaluation should be reserved for those patients requiring colonoscopy. The latter examination should be performed in all children who have had negative sigmoidoscopic examinations plus those who have had polyps removed from the rectum and then again develop hematochezia.

[Radiological appearance of neoplastic and inflammatory changes of the small intestine. A case report (author's transl)]

Accuracy and efficiency of small bowel enteroclysis by means of a roller pump is demonstrated in patients with neoplastic and inflammatory small bowel disease.

Radiologic spectrum of polypoid lesions in ulcerative colitis and Crohn's disease

Various types of polypoid lesions are found in patients with ulcerative colitis and Crohn's disease. True adenomatous polyps are rare. In addition to the sessile or pedunculated "pseudopolyps" of inflammatory bowel disease, the lesions may also assume a filiform shape or reach a giant size. These polypoid lesions are inflammatory in nature and therefore have no malignant potential. Awareness of the benign nature of these lesions is important in the management of patients with inflammatory bowel disease. Unnecessary surgery may be prevented by endoscopic biopsy for confirmation of their inflammatory nature. Representative cases illustrate the ability of the double contrast technic to clearly depict these polypoid lesions.

Reliability of barium enema in detecting colonic neoplasia

Three hundred and seven unselected patients were examined by double contrast barium enemas. Twenty-four patients (7.8%) had carcinomas; 11 patients (3.6%) had polyps; six patients (2%) had possible polyps, not confirmed by colonoscopy; and in four patients (1.3%) the radiological findings were misleading or wrong. No carcinoma was missed by barium enema X-ray examination, to be diagnosed by other means. Two patients had radiological lesions, not demonstrable endoscopically, but confirmed surgically. Extensive follow-up of 286 patients (93.2%) revealed only one subsequent case of carcinoma. The shortcomings of colonoscopy are briefly discussed. It is recommended that barium enema examination precede colonoscopy in the investigation of suspected large bowel neoplasia, and that both be used alternately to screen high-risk patients.

Colonoscopic polypectomy

Seven hundred and forty-one colonic polyps have been removed by colonoscopic polypectomy during 300 examinations. Up to 36 polyps were removed at a single examination. Colonoscopic treatment of villous adenomas to 7 cm has been successfully performed in elderly and infirm patients. There were no deaths or incidents of perforation and the only significant complications were two secondary haemorrhages requiring transfusion. The presence of a polyp was not definitely reported in 40% of barium enema X-ray examinations carried out within three months of polypectomy. Double contrast X-ray examinations were significantly more sensitive in the detection of polyps. Colonoscopic polypectomy is a safe and effective technique. All colonic polyps should be removed by this technique after diagnosis.

Continent ileoanal endorectal pull-through

Five patients with familial polyposis coli, ages 13 through 21 yr, were given the choice of permanent reservoir-type ileostomy or ileoanal endorectal pull-through to prevent cancer of the colon. Total colectomy and an ileoanal endorectal pull-through was uniformly chosen and was performed using the principles described by Boley and Soavè. The post-operative courses were characterized by a transition from 8 to 10 liquid stools per day and up to 3 incontinent nocturnal stools, to a bowel pattern of 2 to 4 continent semi-liquid stools without nocturnal soiling by 1 mo. Defecograms at 1 mo revealed excellent sphincter function and mild reservoir dilatation of the ileum. These observations have convinced us that this is the operative management of choice for familial polyposis.

Unusual inflammatory processes involving the colon

Six patients with unusual inflammatory lesions of the colon are presented. Several of these cases demonstrated unusual presentations of an unusual disease. The clinical and radiologic features (which together are of paramount importance in suggesting the correct diagnosis) are discussed. Important differential diagnostic considerations are listed.

Inaccuracy of radiographic measurements of colon polyps

Polyp size is one of the main determinants of the surgical management of polyps in areas without colonoscopy services. We reviewed 47 patients with 59 polyps at two hospitals. Polyp dimensions were measured directly from air contrast barium enema radiographs, and again after resection and fixation. In over 95% of polyps the radiographic size exceeded the pathologic size by 10 to 100%. Since surgery may be decided on the basis of polyp size, an inaccurate measurement may result in unnecessary colonoscopy or laparotomy. We therefore recommend a correction factor derived from measuring a rectal tube of known diameter.

Bile duct carcinoma associated with chronic ulcerative colitis

Patients with chronic ulcerative colitis are prone to a variety of liver disorders. This case report illustrates development of bile duct carcinoma in a patient with long-standing inactive colitis. The report emphasizes the association of chronic ulcerative colitis with bile duct carcinoma and discusses the radiologic preoperative evaluation of the ulcerative colitis patient who develops jaundice.

Resolution of radiographic-endoscopic discrepancies in colon neoplasms

Fifty-one colon neoplasms larger than 1 cm were diagnosed by double-contrast barium enema (DC), but were not confirmed by initial endoscopy. Seventeen lesions were shown to be radiographic false-positive diagnoses by careful review of the original radiographs (10 cases) or repeat DC (7 cases). The presence of a neoplasm was confirmed in 21 cases (41%) by repeat endoscopy or surgery (15 cases) or by repeat DC alone (6 cases). Seven (47%) of 15 resected lesions were malignant. The results emphasize the complementary nature of the DC and endoscopy in detection of colon neoplasms. When discrepancies between the radiographic and endoscopic diagnoses cannot be explained by careful review of the DC, repeat radiographic or endoscopic examination should be performed.