By Basil C. Morson
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Extra resources for Diseases of the Colon, Rectum and Anus. Tutorials in Postgraduate Medicine
Example text
Chapter Four Radiology A. C. Y O U N G When colonic disease is suspected, it is the first duty of the radiologist to detect and define each anatomical lesion which may present. Each lesion must be so demonstrated that its geometrical features and dimen sions can be positively identified and measured. Earlier methods of barium enema examination showed tumours as filling defects varying in size according to the state of distension of the bowel, and the amount of compression applied to it. Such negative evidence is not comparable with the macroscopic morbid anatomy of a tumour, nor can it be relied upon to make accurate observations of change in size from one examination to another.
This variability of lesions between one segment and the next is characteristic of Crohn's disease. 53 54 DISEASES OF THE COLON, RECTUM AND ANUS Mucosal lesions. T h e normal mucosa is represented by the even, regular line which is the tangential projection of the barium coating. Haustral folds are manifested by a double line. T h e earliest recognizable change is granularity. T h e mucosa, being granular, holds more barium per square centimetre than normal, just as corrugated paper will hold more paint per unit of area than plain paper.
The Radiographic Examination T h e patient lies face down on the table and a rectal tube is inserted. T h e M a l m o stainless steel rectal tube has a spherical nozzle and a second spherical enlargement so placed that it fits snugly against the anal margin when the tube is in position. T h e smooth nozzle and the limitation of insertion imposed by the large sphere make perforation unlikely. Barium is run in as far as the mid-transverse colon. If the barium is held u p the flow is immediately stopped, since the commonest cause of delay is the reflex contraction of the pelvic colon which follows overdistension of the rectum.