Colonoscopy as an adjunctive technique in evaluating acquired colonic narrowing.

Fiberoptic colonscopy is a useful adjunct to the barium enema in establishing the nature of colonic narrowing for which surgical intervention is being considered in patients who are not clinically obstructed. When the mucosa can be demonstrated to be free of disease, celiotomy and resection can be avoided. Even without significant narrowing, it is sometimes possible to limit the extent of resection by proving the process to be benign. On review of 500 consecutive colonscopic procedures, "colonic narrowing" was the indication or finding in 47 patients. Barium enema had been inconclusive in 34 of these, whereas colonoscopy was inconclusive in only seven. In 34 patients the decision concerning surgical amangement was influenced by colonoscopy, and the accuracy of the endoscopic findings in the majority was confirmed by biopsy, laparoscopy, or celiotomy. On the basis of radiographic and endoscopic studies, 29 patients were not explored and in none was there delay or failure in the diagnosis of malignancy. There were no complications or deaths. Three illustrative cases are presented with correlative endoscopic and radiographic material.

The primary double-contrast examination of the postoperative stomach.

Examination of the postoperative stomach is a difficult and often confusing procedure. Traditional methods of investigation have depended on using small amounts of barium as well as appropriate pressure and positioning. The authors feel that the well-established technique of double-contrast radiography of the upper gastrointestinal tract (with appropriate modifications) is both easier and more diagnostic; moreover, with the exception of suspected perforation or anastomotic rupture, there are no contraindications to the use of gastrointestinal hypotonia, distension, and barium coating of the mucosa regardless of the presenting symptomatology or the acuteness or chronicity of complaints.

Prolapsing neoplasms of the terminal ileum simulating enlarged ileocecal valves.

Prolapsing and/or intussuscepting neoplasms of the terminal ileum are an uncommon cause of a prominent ileocecal valve as seen on a barium enema. Because of their varying position, these lesions require several spot films with reflux into the terminal ileum for their detection and accurate diagnosis. Five cases are described and illustrated, four lipomas and one carcinoid.

Splenic flexure carcinoma as a source of hepatic portal venous gas.

Most patients with hepatic portal venous gas are seriously ill with some combination of bowel ischemia, distension, and/or necrosis. The authors report a case in which a necrotic splenic flexure carcinoma seeded gas and septic thrombi to the liver.

Association of intraluminal duodenal diverticulum with acute pancreatitis.

A case of acute pancreatitis is reported in a patient with an intramuinal duodenal diverticulum. Five previous reports of this association are cited, and the mechanisms through which the intraluminal duodenal diverticulum may cause pancreatitis are reviewed.

Laryngeal granular cell myoblastoma two case reports with radiographic demonstration.

Laryngeal granular cell myoblastoma is a rare, benign lesion. Two cases were studied by contrast laryngography and demonstrated similar, non-specific findings of a smooth, sessile mass.

Computed tomography and the dilated pancreatic duct: an ominous sign.

The main pancreatic duct has been visualized with both ultrasound and computed tomography. A normal pancreatic duct has not been reported using CT, and controversy persists over whether a normal duct can be routinely imaged with ultrasound. The dilated pancreatic duct has always been associated with disease -- usually pancreatitis or a proximal obstructing pancreatic carcinoma. In the patient with no clinical history or laboratory data suggesting pancreatitis, a dilated pancreatic duct implies a proximal tumor.

Comparative detection of pancreatic body--tail enlargement using the supine translateral and axial pancreatic views: a prospective statistical study.

A prospective statistical study of 429 patients was undertaken to determine if the axial pancreatic view would improve detection of pancreatic body-tail enlargement. This view is produced by directing a roentgen-ray beam along the axis of the pancreatic body-tail cylinder. On this view and on the supine translateral view, a pancreatic body-tail space can be identified as a subdivision of the retrogastric space. When the pancreatic body-tail enlarges, this space selectively enlarges. The percentage change of this space is particularly impressive on the axial pancreatic view, where 10 of 12 pancreatic body-tail neoplasms were detected with only a 1.8 per cent false positive rate.

Pneumatosis and cystoides intestinalis. Report of a case with colonoscopic findings of inflammatory bowel disease.

A patient with pneumatosis cystoides intestinalis noted on barium enema performed for evaluation of rectal bleeding was found on fiberoptic colonoscopy to have evidence of inflammatory bowel disease, consistent with granulomatous colitis, the sigmoid colon element of which responded to topical steroid therapy as documented by repeat colonoscopy three months later.

Multiple gastric ulcers: a radiographic sign of benignity?

Twenty-nine cases of multiple synchronous gastric ulcers are reviewed. Twenty-three were benign and 6 were malignant. Seven illustrative cases are presented. Multiplicity of gastric ulcers is not a reliable sign of benignity and may complicate rather than clarify diagnostic evaluation.

The clinical significance of cervical esophageal and hypopharyngeal webs.

One thousand consecutive cinefluorographic examinations of the hypopharynx and cervical esophagus were reviewed to determine the incidence of webs in a population routinely referred for upper gastrointestinal examination. The age, sex, and incidence of iron deficiency anemia in patients with webs were compared with those of the controls, and dysphagia and associated diseases were noted. 5.5% of the patients had one or more webs; these patients had a similar sex distribution to the control group but were generally older. Both groups had the same incidence of iron deficiency anemia. None of the patients with webs met the criteria for Plummer-Vinson syndrome. The authors believe that most cervical esophageal and hypopharyngeal webs are of no clinical significance.

Early gastric cancer: radiographic experience.

Early gastric cancer (EGC) is currently defined as an adenocarcinoma limited to the mucosa or to the mucosa and submucosa with or without perigastric lymph node involvement. To evaluate the radiologic features of this tumor, the radiographs of 21 cases were reviewed. Four were Type I (protruded) tumors, eight were Type II (superficial) including two mixed lesions, and nine were Type III (excavated), containing evidence of true ulceration. A retrospective analysis of radiographic findings indicated that nine of the tumors (43%) were either suspicious or diagnostic for malignancy on at least one examination, four (19%) were thought to be benign, and eight (38%) showed no identifiable lesion in the region of the stomach subsequently shown to contain an early cancer. The location, size, histology, gross morphology, and survival data, even in the face of perigastric lymph node involvement, all suggest that the early gastric cancer reported in this and other Western series is the same as that reported by the Japanese. The data further suggest that the incidence of EGC in the West is higher than traditionally thought.