[Roentgen diagnosis of the large intestine with special reference to the double-contrast method and its significance in tumor diagnosis]

In the X-ray examination of the large intestine by means of the retrograde contrast medium enema on extreme filling radiographs as well as on radiographs of the mucous membrane small tumours can be overseen. The same applies to the peroral demonstration of the large intestine. Better results are yielded by the double contrast method. Therefore it has been exclusively used in our clinic since 1961. The following prerequisites must be fulfilled for an evident examination: - optimum cleaning of the bowel, - steady and thin contrast medium covering of the intestinal wall and demonstration of all sections of the intestine on 2-3 pictures in different position of the radiograph in every case. Under these conditions polyps of a diameter of 5-6 mm can be demonstrated. With the help of results of the examinations of 1,390 patients it is referred to the importance of the demonstration also of small lesions of the colon. The rate of carcinomas amounted to 14,5%; that of polyps was 6,2%. For 1/5 of the polyps a malignancy was determined histologically.

Involvement of the digestive tract in Cowden's disease

A 28-year-old white man had Cowden's disease and multiple gastrointestinal polyps. Of the 56 cases of Cowden's disease which have been reported so far, esophageal and gastrointestinal involvement have been observed in only 18 patients. Endoscopic, radiologic, and histopathologic features of these lesions were confirmed in the present patients.

Giant pseudopolyposis and antegrade colonic obstruction: report of a case

A case is described in which massive development of pseudopolyps resulted in left colonic obstruction in a patient with a history of ulcerative colitis. Problems of diagnosis and management are discussed, with emphasis on the need for close radiographic and endoscopic follow-up of such patients.

Villous adenomas of the duodenum

Two cases of villous adenoma of the duodenum are presented. One patient had two lesions in the first part of the duodenum, this being only the second report of multiple villous adenomas of the duodenum. One patient was totally asymptomatic and his villous adenoma was diagnosed radiologically during investigation of anaemia, while the second patient had his two villous adenomas discovered incidentally during surgery for a bleeding leiomyosarcoma of the stomach. The two duodenal adenomas in the second patient had been missed on the barium study.

[Ileocecal mucosal prolapse]

Knowledge of normal and pathological anatomy and the radiological picture of the ileocecal valve is very important to avoid false interpretation of polyp-like findings in the cecum. Radiologically, ileal prolapse can pose as a cecal polyp. The radiological diagnosis, large 'cecal polyp' was not confirmed intraoperatively in the case presented.

Sensitivity of double-contrast barium enema: emphasis on polyp detection

Colonoscopically verified lesions (230 in 178 patients) were reviewed and compared to results of double-contrast barium enema studies performed by radiologists specifically interested in gastrointestinal disease. Eighteen carcinomas and 22 cases of colitis found endoscopically were accurately identified radiographically. In 140 patients with 190 polyps, 16 lesions were missed radiologically, a false-negative error for polyps of 8.4%. All undetected polyps were distal to the splenic flexure with the majority located in the sigmoid colon. Thus, the double-contrast barium enema study was quite effective in finding colon polyps, particularly proximal to the splenic flexure.

Radiology in investigation of rectal bleeding

Although most causes of chronic anorectal bleeding are diagnosed from clinical or sigmoidoscopic examination, there are a number of conditions not detectable from barium enema studies. Results of colonoscopy are compared to those for single- and double-contrast barium enema examinations, and recommendations are made for increasing diagnostic accuracy.

Localized giant pseudopolyposis of the colon in ulcerative colitis

Recently a patient with ulcerative colitis developed abdominal pain and a left upper quadrant mass. A 67Ga-citrate scintiscan showed increased activity over the mass. A barium enema demonstrated retrograde obstruction at the splenic flexure and intraluminal multilobulated tissue masses. The total abdominal colectomy specimen showed localized giant pseudopolyposis at the splenic flexure. This condition is a rare local complication of both ulcerative and granulomatous colitis. It resembles a villous adenoma on barium enema and, although inflammatory, may simulate a colonic carcinoma. When symptomatic, local resection may be sufficient treatment.

Detection of intracolonic lesion by barium contrast enema. The importance of adequate colon preparation to diagnostic accuracy

Frequently, the clinical significance of the barium contrast enema is minimal because of inadequate colon preparation prior to examination. The frequency of false-positive routine barium enemas was 17% in 230 consecutive patients who underwent colonoscopy for removal of specific radiographically identified polypoid colon lesions. Initial barium enema inaccuracies were documented with postendoscopic air-contrast radiography in colons that were endoscopically proved to be mechanically clean following a two-day colon preparation. These results suggest that more emphasis on a two-day colon preparation, before the initial barium contrast enema, would substantially reduce the frequency of false-positive interpretations.

Blue rubber bleb nevus syndrome

Two cases of pediatric blue rubber bleb nevus syndrome are reported. The main features of the disease are rubbery blue cutaneous nevi and hemangiomatous, frequently hemorrhagic malformations of the bowel wall. Polypoid filling defects were seen throughout the bowel on barium studies. This entity should be considered in the differential diagnosis of polyposis, and the skin should be carefully examined for nevi when multiple bowel polyps are demonstrated, especially in patients with gastrointestinal bleeding.

Left-sided colonoscopy in the office: a practical procedure

Routine left-sided colonoscopy, instead of sigmoidoscopy, is a practical office measure. However, details of preparation and positioning of the patient are critical. The procedure has high productivity worth the added cost and effort. Cancer prevention is enhanced. Barium-enema examinations were found to have limited accuracy in polyp discovery, to a degree not previously appreciated.

[Radiological diagnosis of colorectal polypi and carcinomas which have not progressed]

Provided examination conditions are optimal, we are now able to detect changes of the wall of the colon from about 5 mm diameter upwards and thus to further clarify the diagnosis and to initiate appropriate treatment. Hence, the demand for early or timely diagnosis can be met by means of x-ray diagnosis in respect of processes of the colon.