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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)
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 ??