Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease

بسم هللا الرحمن الرحيم

Dr. Ahmed Abdallah Eisawy

MBBS M.Sc MD

Enteroclysis

Fast

Mucosa

No overlap

Less Rad.

SBFT

Dilatation

Transit time of Ba

Small bowel

Single Contrast Single Contrast

DC Ba enema

obstruction

Diverticulitis

Ca, Mucosa

Routine: IBD, polyps

Large bowel

Barium studies : Diagnostic findings

1.Sub-mucosal infiltration

2.Dilatation

3.Separation

4.Ulcer

5.Strictures

6.Filling defects

7. Out-pouching

8- Dilution

Cardinal signs of malignancy

Mucosal destruction

Mass

Obstruction

Shouldring

Filling defect

stricture

Sub-mucosal infiltration

• Sub-mucosal infiltration of small bowel (by edema, blood, lymph tissue or neoplasm)

• According to the extent of infiltration 2 patterns exist: stack-of-coins and picket fence

Stack-of-coins

• Stack-of-coins :small amount of infiltration leads to mildly thickened mucosal folds.

• Differential diagnosis includes sprue and scleroderma; they can be further differentiated by dilution of barium due to increases secretion in sprue but not in scleroderma.

Picket fence

• Picket fence :larger amount of infiltration leading to markedly thickened folds.

• It includes Whipple's disease, lymphoma, ischemic or radiation enteritis, tuberculosis & Crohn's disease. Remarkable dilatation of loops in Whipple's disease differentiates this disease from other causes

Ba : Sub-mucosal infiltration

Stack-of-coins Picket fence

Sprue

Stack-of-coins dilatation

Dilution No dilution

Scleroderma

Sprue. celiac disease shows dilatation, contrast-agent dilution, intussusception, barium flocculation, and jejunization of the ileum

+/- Dilated Non-dilated

Whipple’s

Disease Ischemia Hemrrhage Radiation lymphoma

ti

n

g

Picket fence

DD

lymphoma

Polypoid mass

picket fence

Dilatation

• in Whipple' s disease, aneurysmal dilatation in lymphoma .

Lymphoma

Sometimes the excavation appears to

represent a widened area of lumen =

aneurysmal dilatation

Radiographic Features 5 = by Marshak et al

(iv) endoexoenteric with excavation and fistula formation

Separation of bowel loops

• Any process that infiltrates or thickens the bowel wall or mesentery can produce separation of bowel loops.

• Differential diagnosis includes Crohn's disease, lymphoma, carcinoma Carcinoid.

Lymphoma

Sprue pattern

• Segmentation, fragmentation, secretions.

• Separated bowel loops due to

lymphomatous bowel wall infiltration

Lymphoma

Intraluminal filling defects

Intramular

Multiple nodules

Strictures:

• malignant strictures may have an apple core appearance being short with abrupt concentric or irregular luminal narrowing.

• Benign strictures as in ischemic or inflammatory bowel (e.g. Crohn's) tend to be long with less irregularity

Radiation enteritis

Localized folds thick

stricture

Aneurysmal

dilatation

stricture

Separated

loops

lymphoma

Malignant VS Benign stricture A-benign stricture in crohn‘s disease .enteroclysis show a long

benign stricture of a jejunal loop(arrowheads) and a jejunocolic

fistula(arrows)

B-malignant colonic stricture.barium enema shows apple-cole

stricture

Ulcerative colitis

Malignant VS Benign stricture

Benign stricture malignant

Long segment Short segment

Gradual Abrupt

Smooth Mucosal destruction

Crohn disease. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates several narrowing and stricturing, consistent with the string sign. Also note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.

Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. Images show total colitis and extensive pseudopolyposis

Synchronous annular carcinomas in the ascending colon and splenic flexure.

• Out pouching of bowel wall

diverticula

Diverticulitis

Diverticular Dse of Colon

Ulcerations

• characteristic fissuring ulcers in Crohn's differentiates it from shallower broader ulcers in ulcerative colitis

Crone disease. Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.

Filling defects

• Multiple filling defects in the bowel include a wide differential diagnosis :polyposis, lymphoma, enteritis and Pseudomembranous colitis (PMC)

Filling defects

PMC

intestinal obstruction due to ChronicCA descending colon

Dilated bowel

loops proximal to

the obstruction.

Arrow points to the

etiology of

obstruction

Barium enema

Intussusception (Claw sign)

The rectally

administered contrast

material draws around

the head of the

intussusception (arrow)

(Claw sign)

LIMITATION OF BRAIUM

1. No direct visualization

bowel wall / extra-mural

2. Ionizing radiation

3. Patient acceptability ??