The value of double-contrast barium enema in amebic colitis

We report here our findings on the double-contrast barium enema given to 8 patients with amebic colitis and a comparison is made with endoscopic features. A definite diagnosis of amebic colitis was made by fecal examination or by endoscopic biopsy. Radiologic findings included fine marginal serration, aphthoid ulcers, minute barium flecks, marginal defects, loss of haustration, and deformities of the bowel. Aphthoid ulcers and marginal defects are both characteristic of amebic colitis. The double-contrast barium enema is most useful for differentiating amebiasis from other forms of colitis.     

Nonspecific radiographic abnormalities in collagenous colitis

Collagenous colitis (CC) is characterized clinically by a chronic, watery diarrhea. Pathologically, there is a chronic lymphocytic infiltrate with abnormal thickening of the subepithelial collagen layer. This disease occurs predominantly in females, and is more frequent in the elderly. Previous clinical studies suggest that radiographic examination of the colon is of no value in this condition. We reviewed five cases of CC all of whom had colon examination within 2 weeks of the biopsy. Two of our patients showed evidence of mucosal granularity and irregularity of the rectosigmoid on double-contrast barium enema (DCBE). One patient had nodularity of the rectal wall on singlecontrast colon examination. Two patients had no inflammatory changes evident on colon examination. These radiographic changes are nonspecific and may be seen in other forms of colitis, particularly ulcerative colitis and nonspecific proctitis.     

Radiographic demonstration of longitudinal ulcers in patients with ulcerative colitis

During the past 10 years, 122 patients with ulcerative colitis were diagnosed by double-contrast barium enema and colonofiberscopy with endoscopic biopsy. Among them, five patients (4%) had longitudinal ulcers and eccentric deformities in the colon. Other radiologic findings included thumbprinting (two cases), sacculations (two cases), and inflammatory polyps (four cases). The possibility of the concomitance of ischemic colitis in cases of ulcerative colitis is discussed, due to their radiographic similarities.     

The “air enema” in acute colitis

The plain abdominal radiograph is an important investigation in acute colitis, but may fail to demonstrate the state of the colon owing to a lack of intracolonic gas. The extent of the colitis can be demonstrated by introducing air directly into the large bowel; the air also provides sufficient contrast to distinguish a granular from an ulcerated mucosa. The air enema may be used as an alternative to an unprepared barium enema. Its accuracy has been established by comparison with an unprepared barium enema in 10 patients with acute colitis.     

Gallium-67-citrate scintigraphy in ulcerative colitis

Gallium-67-citrate scanning was performed in 9 patients with ulcerative colitis. In all patients there was good correlation between the regional uptake of gallium and the extent and activity of disease. In 2 patients the scans were positive during an acute exacerbation and reverted to normal or near normal during clinical remission. In one patient in whom the colon was resected because of toxic dilatation, good correlation was found between pathologic and scintigraphic examinations. During the acute attack of ulcerative colitis, when colonoscopy or barium enema may be contraindicated, gallium scanning may be a noninvasive means of assessing the extent of colonic involvement. It may also be an alternative means of following the clinical course of the disease.     

Ischemic colitis associated with carcinoma of the colon

Two cases of ischemic colitis occurring proximal to carcinoma of the colon are described, with special reference to the barium enema and pathological findings. The association of these two conditions is rare but when present may cause some confusion. It is possible that the two lesions may, for instance, be considered to be both due to ischemic colitis, or mistaken for granulomatous colitis with a stricture.     

Radiographic and endoscopic findings in penicillin-related non-pseudomembranous colitis

The characteristic findings of barium enema and colonofiberscopic studies and their changes over time were investigated in 10 patients with penicillin-related non-pseudomembranous colitis. Radiographic examination within 6 days of onset revealed abnormal findings such as narrowing of the lumen, loss of haustral markings, thumb-printing, transverse ridging, and saw-toothed irregularities. These findings tended to be more pronounced on the right than on the left side of the colon. Endoscopy revealed lesions characterized by mucosal reddening, edema, and hemorrhage, without definite ulceration or erosion. In 5 of the 10 patients, non-continuous distribution of the lesions was noted. In 4 patients, the rectum was unaffected. Reversion to normal occurred within an average of 15.7 days following onset of the symptoms. Thus, for an accurate diagnosis of this disease, barium enema and/or total colonoscopy should be performed within 6 days of onset.     

Amyloidosis of the colon presenting as ischemic colitis: A case report and review of the literature

Review of the English literature revealed 21 cases describing abnormalities on barium enema secondary to amyloidosis of the colon. These cases were categorized as to frequency of specific barium enema findings and distribution within the colon. The most common radiologic findings were luminal narrowing (11 of 21), loss of haustrations (10 of 21), thickened mucosal folds (8 of 21), mucosal nodularity (8 of 21), and ulceration (6 of 21). The most frequent locations of disease within the colon were the descending and rectosigmoid portions (13 of 21). We present a case of primary amyloidosis that demonstrates the findings of bowel wall thickening and luminal narrowing on doublecontrast barium enema and computed tomography (CT). Pathologic examination in our case, in addition to similar observations from the literature, suggests that at least a part of the radiologic changes of colonic amyloid can be attributed to bowel ischemia.     

显微镜结肠炎临床特征及其相关危险因素分析

目的分析慢性腹泻患者的临床、内镜及病理资料,探讨可能影响显微镜结肠炎(MC)的危险因素。方法前瞻性分析2016年6月-2017年4月该院门诊以水样腹泻为主诉患者的临床资料,常规结肠镜检查,多点取肠黏膜活检,行组织病理HE染色和Masson染色,对患者的病史及病理进行分析。结果 102例水样腹泻患者中诊断为MC 3例(3/102,2.94%),其中胶原性结肠炎(CC)3例,全部为女性,年龄24~36岁,淋巴细胞性结肠炎(LC)0例。结肠镜下肠黏膜基本正常或仅表现为轻度的充血水肿;病理组织学表现为上皮细胞损伤,上皮内淋巴细胞增多,固有层炎症细胞浸润,上皮下胶原带增厚。近期服用降糖药、质子泵抑制剂(PPIs)、面食等因素可能与MC发病关系密切。结论 MC是慢性水样腹泻的重要原因,临床症状及结肠镜表现均无特异性,慢性腹泻患者应尽早行结肠镜下多点活检明确诊断,其发病可能与使用某些药物(如降糖药、PPIs)和某些食物(面筋)有关。     

Colonoscopic diagnosis and medical treatment of ten patients with colonic tuberculosis

Ten patients with tuberculous enterocolitis were diagnosed colonoscopically. In four, the diagnosis was confirmed by positive acid fast stain or the presence of caseating granuloma in colonic biopsy material or ileal washings. In one other patient a cervical lymph gland revealed acid-fast bacilli. He was the only patient with extraintestinal disease, indicating that primary tuberculous colitis is probably more common than secondary in Saudi Arabia. In the other five patients the colonoscopic diagnosis was confirmed by a complete response to antituberculous triple therapy. Six patients had hypertrophic, two ulcerohypertrophic and two widespread ulcerative lesions. Colonoscopy with biopsies has definite advantages over barium enema in diagnosis. After thus excluding malignancy, Crohn's disease remains the most important differential diagnosis. A ten-week therapeutic trial of antituberculous treatment is recommended in patients from high-risk populations with a typical history and colonoscopic picture to avoid the morbidity and mortality of diagnostic laparotomy.     

Aphthous lesions in nodular lymphoma of the colon

The umbilicated nodules in colonic lymphoma may simulate aphthous ulcers of inflammatory or infectious colitides. Our report illustrates that in an immunosuppressed patient it may be difficult to distinguish on double contrast barium enema between the aphthous ulcers of opportunistic colitis and the umbilications of nodular colonic lymphoma.     

The role of barium enema in detecting colorectal disease. A radiologist's perspective.

The single-contrast barium enema examination remains useful for patients with acute diseases such as bowel obstruction, diverticulitis, appendicitis, and fistulas. It is also the procedure of choice for those patients who are too elderly, debilitated, or ill to cooperate with the maneuvers necessary for a double-contrast examination. The double-contrast technique is more sensitive than the single-contrast technique for detection of polyps, early inflammatory bowel disease, and lesions of the rectum. In the older population, there has been an increase in the incidence of colonic polyps and carcinomas in the right side of the colon. This emphasizes the need to examine the entire colon in these patients. The double-contrast barium enema is a safe, accurate, and cost-effective tool for accomplishing this. It is also recommended as the initial procedure in the examination of patients with positive results on fecal occult blood testing.     

Diagnosis of ulcerative colitis--barium enema examination

Barium enema is useful especially for differential diagnosis of right sided type or segmental type of ulcerative colitis from other inflammatory bowel diseases. Compared with endoscopical examination, it provides more objective informations about the range of affected colon which is necessary for the choice of treatment strategy to the reluctant case. However, as preparation procedures may cause aggravation of ulcerative colitis, an unnecessary barium study should be avoided. Even the case in remission stage, it is advisable to add 40 to 60 mg of water-soluble predonisolone to barium solution. Roentogenographic diagnosis of ulcerative colitis is not difficult, in so far as two major points are properly evaluated. The first is the presence or absence of haustration, and the second is mucosal surface of the colon, namely, multiple ulcers or erosions distributing diffusely and continuously in active stage, or granular mucosa and disarray of network pattern of colonic mucosa in remission stage.     

Treatment of mild and moderate ulcerative colitis

Selection of treatment for ulcerative colitis is based on the definition of clinical severity. In those medication is a main course. Mild and moderate cases are treated mainly with salicylazosulfapyridine or mesalazine. Patients with proctitis-type are added betamethazone suppositories and those with left-sided and total colitis-type predonisolone enema therapy simultaneously. If there is no response, they are given additional oral predonisolone. Even after remission, patients should be carefully observed. A good patient-physician relationship, continuation of maintenance therapy, and periodic follow-up examinations using colonoscopy or barium enema are essential to successful long-term management of this disease. Patients who have repeated relapsing should receive the stronger treatment, according to the endoscopic findings and clinical course in addition to the clinical severity.     

Fecal occult blood testing. Problems, pitfalls, and diagnostic concerns

The diagnostic approach to the asymptomatic patient who has tested positive for fecal occult blood varies among clinicians. Colonoscopic evaluation is the procedure of choice in initiating the workup of patients 50 years of age and older. In younger patients, examination by sigmoidoscopy and barium enema using air for contrast (double contrast study) may be considered as an alternative to colonoscopy as the initial test. Evaluation of the upper gastrointestinal tract should be considered if a colonic source is not detected. The challenge in diagnostic test selection lies in choosing the most appropriate and cost-effective procedure for detecting disease, especially neoplastic lesions.     

缺血性结肠炎56例结肠镜及临床特点分析

目的 研究缺血性结肠炎的临床特点、结肠镜特征及诊治要点.方法 回顾性分析56例缺血性结肠炎的临床资料及结肠镜特征.结果 缺血性结肠炎好发于老年人,多有相关基础疾病,女性多于男性(2.5%vs 1.4%,P＜0.05),主要表现为急性腹痛、便血及腹泻.结肠镜检查:结肠脾曲、降结肠及乙状结肠最容易受累.病变黏膜和正常黏膜分界清楚,表现为黏膜苍白水肿、瘀斑、黏膜下出血、糜烂以及溃疡.多表现为一过性,若能早期诊断治疗,预后良好.结论 具有心、脑血管疾病或糖尿病的老年患者出现急性腹痛、便血、腹泻,应考虑可能合并缺血性结肠炎,及时行结肠镜检查.结肠镜检查在明确诊断、早期治疗和判断预后上有重要意义.     

Conditions that mimic inflammatory bowel disease. Diagnostic clues and potential pitfalls

Many of the features that identify idiopathic inflammatory bowel disease are also found with other colorectal conditions that are often encountered by the primary care physician. Although, initially, symptoms of these disorders may appear to be caused by ulcerative colitis or Crohn's disease, the cause could be bacterial, viral, parasitic, or fungal infection. Ischemic colitis and radiation colitis are other conditions that are similar in presentation to ulcerative colitis. In most cases, the physician should be able to make a differential diagnosis from a thorough history and physical examination, anoscopy or sigmoidoscopy, rectal biopsy, stool examination, and serology. An occasional patient, in whom diagnosis is not made by these methods, may require a barium enema study, colonoscopy, or referral to a gastroenterologist.     

内痔的X线诊断

目的　研究内痔的造影检查表现及放射科检查对内痔的诊断价值。方法　对 1994-1998年经我院内窥镜检证实的 2 2例内痔病人 (其中男 10例、女 12例 )进行了结肠低张双对比造影检查 ,观察肛管直肠移行处的改变。结果　肛管直肠移行处见一个或多个结节 8例 ,皱褶增粗或呈分叶状者 10例 ,皱褶规则、无分叶、且宽径在 3mm以下 1例 ,移行处光滑无皱褶 3例。结论　双对比造影检查对内痔的诊断是有价值的 ,其敏感性是 81.82 %。     

Colitis, cancer, and colonoscopy.

Colonoscopy has added a new dimension to the diagnosis of colonic diseases. In the field of inflammatory bowel disease, colonscopy is indicated only when certain specific problems arise. Patients with acute colitis and those who are too sick to withstand cleansing enemas should not undergo colonoscopy. A major use of the colonoscope is in the detection of carcinoma in the colitic colon either in the form of colonic strictures or filling defects discovered by barium enema x-ray, or in the long-term surveillance of patients with universal ulcerative colitis. Criteria are listed to assist in the colonoscopic differential diagnosis between ulcerative and granulomatous colitis. By using different criteria than the radiographer, and with the help of biopsy specimens, a high degree of accuracy in proper diagnosis can be achieved.     

Sonography of colonic diverticulitis

Sonographic findings in 16 patients with diverticulitis of the colon are described. The wall of the inflamed segment of the colon appeared hypoechoic and thickened. Maximum thickness of the wall ranged from 5 to 17 mm. Length of the most severely inflamed segment of the colon ranged from 6 to 9 cm. In addition, adjacent contiguous segments of the colon, less involved with inflammation, ranging in length from 7 to 15 cm, were demonstrated on sonographic examination of five patients. Long segments of the inflamed colon could be demonstrated by oblique scanning. The appearance of the mucosal reflections, intramural abscesses, and inflamed diverticula is described. Out of 16 patients with diverticulitis, seven patients had abscesses and extravasation of barium was seen in only two of these seven patients. Ultrasonography therefore is recommended prior to barium or water-soluble contrast enema examination in patients with suspected diverticulitis. In patients with appropriate clinical findings, sonographic diagnosis of diverticulitis can be made by demonstrating hypoechoic thickening of the wall of the colon, even in the absence of intramural or intraperitoneal abscess.