Normal OesophagusBarium swallow examination: Lateral view: The
course and diameter of the esophagus are normal, the longitudinal
mucosal folds are regular.
Normal Stomach Postcontrast examination: The stomach is of
normal size and shape, its mucosal folds are regular. The fornix is
filled with contrast material because of the supine position. The
duodenum is normal. Jejunal loops filled with contrast material are
visible behind the stomach.
Colon relief(monocontrast examination)Barium enema: After
evacuation of the contrast material, the course and themucosal
relief of the colon is visible.The terminal ileum is also
Contrast examination: The entire gastrointestinal tract is
filled with contrast material. All parts of the tract are well
Acalasia Barium swallow examination: Early stage: The esophagus
has smooth contour and is narrowed conically at the
esophago-cardial junction (arrow), above this the distal part of
the esophagus is dilated. (=> picture)
Barium swallow examination: Late stage: The esophagus is
extremely dilated above the severely narrowed cardia (arrow), with
a slightly tortuous course and inhomogenous contrast material
filling pattern because of the residual food inside.
Case 2ESOPHAGEAL ATRESIA
EA is a condition in which the proximal and distal portions of
the esophagus do not communicate
Clinical signs The first clinical sign of an infant with EA is
maternal polyhydramnios resulting from the infant's inability to
swallow and absorb amniotic fluid through the gut.Excess salivation
and fine, frothy bubbles in the mouth and sometimes nose result
from an inability to swallow. Any attempts at feeding result in
choking, coughing, cyanotic episodes, and food regurgitation.
Examination with contrast material: The arrows point to the
blind end of the esophagus filled with contrast material. The
middle lobe of the right lung is partially atelectatic because of
aspiration. Presence of a lower fistula is suggested by the
presence of gas in the distended stomach.
Picture 3. H-type tracheoesophageal fistula (TEF). Oblique
barium esophagogram demonstrates a fistula (arrow) arising from the
anterior esophagus and extending anterosuperiorly to the trachea.
Picture Type: X-RAY
CASE 3Hypertrophic Pyloric Stenosis
Clinical History: 2 month old male with a history of recurrent
vomiting after meals.
Findings: Thickening and elongation of the pyloric canal. The
muscle wall thickness is 5-6 mm. The pyloric canal measures
approximately 21 mm.
X-RAY Abdominal radiographs may show a fluid-filled or
air-distended stomach, suggesting gastric outlet obstruction. A
markedly dilated stomach with exaggerated incisura (caterpillar
sign) may be seen, which represents increased gastric peristalsis
in these patients
Findings on UGI include the following: Delayed gastric emptying
(if severe, this may prevent barium from passing into the pylorus
and severely limit the study) Cephalic orientation of the pylorus
Shouldering (ie, filling defect at the antrum created by prolapse
of the hypertrophic muscle) Mushroom or umbrella sign (ie,
thickened muscle indenting the duodenal bulb (refers to the
impression made by the hypertrophic pylorus on the duodenum) Double
track (ie, redundant mucosa in the narrowed pyloric lumen, which
results in separation of the barium column into two channels)
String sign (ie, barium passing through the narrowed channel
creating a single, markedly attenuated and elongated track) Pyloric
tit (ie, outpouching created by distortion of the lesser curve by
the hypertrophied muscle) Retained secretions and retrograde
Postcontrast examination: 24 hours after drinking contrast
material most of it is still visible in the stomach with residual
food above it. The stomach is dilated, its lower pole hangs below
the iliac crest. Only minimal contrast material filling is observed
in the small intestines.
CASE 4Duodenal Atresia
Duodenal atresia represents complete obliteration of the
duodenal lumen The etiology of duodenal atresia and stenosis is
unknown Anatomy: In most cases, duodenal atresia occurs below the
ampulla of Vater. In a very few cases, the atresia occurs proximal
to the ampulla.
X - RAY Findings: The double-bubble sign represents dilatation
of the stomach and duodenum. This configuration most commonly
occurs with duodenal atresia and an annular pancreas. An annular
pancreas is almost always associated with duodenal atresia.
Contrast material examination: The distended stomach and
duodenum above the obstruction are visible after swallowing
contrast material (arrows).
Plain radiograph of the abdomen: The arrows point to
characteristic gas bubbles in the stomach, duodenum and
CASE 5Hirschsprung Disease
Synonyms and related keywords: congenital megacolon, aganglionic
megacolon, aganglionosis, HD HD is characterized by the absence of
myenteric and submucosal ganglion cells in the distal alimentary
tract. The disease results in decreased motility in the affected
Clinical Details:Newborns with HD come to medical attention with
the following symptoms: Failure to pass meconium within the first
48 hours of life Abdominal distension that is relieved by rectal
stimulation or enemas Vomiting Neonatal enterocolitis
Symptoms in older children and adults include thefollowing:
Severe constipation Abdominal distension Bilious vomiting Failure
Picture 1. Hirschsprung disease. Barium enema showing reduced
caliber of the rectum, followed by a transition zone to an
Barium enema: An approximately 1 cm long segment of the colon is
narrow (arrow) in the recto-sigmoideal region, above which the
colon is markedly dilated, the haustration disappeared
Barium enema: The contrast material outlines a bowel segment
without ganglions (arrows), above which prestenotic dilatation is
Invagination of a bowel segment (usually small bowel) into the
lumen of the more distal bowel (usually colon) occurs
Venous congestion is a major factor both in symptomatology and
in the characteristic presence of blood in the stool.
Clinical DetailsMost intussusceptions are acute andpresent in a
well-nourished infant with signsand symptoms of bowel obstruction
asfollows: Cramping abdominal pain Poor feeding Vomiting
Barium enema: The rectally administered contrast material draws
around the head of the intussusception (arrow).
Meconium Plug Syndrome
Findings: Image #1 is a plain film of the abdomen which
demonstrates findings suggestive of a low intestinal obstruction
with multiple air-filled, distended loops of bowel. Image #2 is a
single view from a Gastrografin enema which demonstrates a
relatively small caliber left colon with an intraluminal filling
defect extending proximally to the hepatic flexure. There is
contrast within the stomach from a previous upper GI.
Barium enema: The rectally administered contrast material fills
the vagina (arrow) and the urinary bladder (double arrow).