Optimal double-contrast visualization of the posteriorly directed duodenal bulb

The posteriorly directed duodenal bulb can be difficult to demonstrate because of the overlapping gastric antrum. A technique is described for displacing the antrum from the bulb while simultaneously distending the barium-coated duodenal bulb with air.     

Adult Hirschprung disease: radiographic findings

Hirschprung disease is usually diagnosed in infancy. Occasionally patients reach adulthood without diagnosis or treatment. Four cases of adult Hirschprung disease are described. The principal radiographic findings are a markedly dilated, feces-filled colon above the zone of transition; a narrowed rectum; a cone- or funnel-shaped zone of transition; and a mosaic colonic pattern caused by collapsed redundant mucosa after colonic cleansing. In an adult, identification on a barium enema examination of an abrupt, smooth transition zone in the rectum with proximal colonic dilatation, in conjunction with an appropriate clinical history, should suggest the diagnosis of adult Hirschprung disease.     

Suspected recurrent rectosigmoid carcinoma after abdominoperineal resection: MR imaging and histopathologic findings

Eleven patients who underwent abdominoperineal resection for rectosigmoid carcinoma were examined with magnetic resonance (MR) imaging for suspected recurrent tumor in the presacral space. There were 12 suspected masses in the 11 patients. Ten lesions were malignant, and in two lesions only nonneoplastic inflammatory tissue was found. The signal intensity (SI) of each lesion relative to that of muscle was determined visually and correlated with the histologic findings at surgery or biopsy. The SIs of malignant and benign lesions were indistinguishable. All lesions showed areas of high SI that correlated with carcinoma and tumor necrosis or with non-neoplastic inflammation and edema. Areas of low SI corresponded to reactive fibrous tissue (desmoplastic reaction) with small islands of tumor or to nonneoplastic fibrosis. MR imaging can be useful in determining the extent of suspected tumors, but SIs on T2-weighted images do not permit histologic diagnosis. In particular, distinction of benign from malignant tissue is difficult in tumors with a desmoplastic reaction.     

Benign esophagorespiratory fistulas in adults

Four benign esophagorespiratory fistulas, three secondary to granulomatous disease and one presumed to be congenital, have been diagnosed in adults at the authors' institution in the past year. The patients had symptoms of chronic or recurrent pulmonary infections, and two experienced coughing after swallowing. Chest radiographs demonstrated refractory consolidation, with or without cavitation and frequently accompanied by an air-distended esophagus. Barium studies were diagnostic. All patients responded well to antibiotic and surgical therapy.