Intussusception in infancy and childhood.

Experiences of the diagnosis and treatment of 41 patients with intussusception are presented. The most common signs and symptoms upon presentation were vomiting (83%), colicky pain (83%), rectal bleeding (66%) and abdominal mass (51%). All four features occurred together in only 20% of cases. Ultrasound was the primary mode of investigation in four children, giving a finding characteristic of intussusception. 27 patients were examined with barium enema, and hydrostatic reduction was tried. A barium enema gave the correct diagnosis on all cases and a successful reduction of sign and symptoms in 12 patients (44%). In the other 29 cases laparotomy was performed to achieve reduction, primarily in 14 patients and after an unsuccessful barium edema in 15.84% of the patients presenting after a delay of more than 24 hours needed surgery, compared with 59% of those presenting earlier.

Radiological findings in small-bowel tumours.

Radiological findings were evaluated in a series of 25 cases with malignant and three with benign small bowel tumours with surgical or autopsy confirmation of diagnosis. 27 patients were operated, two of them without any radiography due to 'acute abdomen'. 23 patients were examined with ultrasound, 14 with barium examination, seven with CT, four with plain films and two with angiography. Ultrasound revealed 16 (70%) out of 23 tumours, in two cases result was abnormal but the tumour was not found and in five cases no abnormality was identified. Eleven barium examinations (78%) showed signs of tumour, one showed signs of occlusion but not the tumour and in two cases no abnormality was found. The tumour was seen in six of seven cases examined with CT. Our results proved that US is useful as screening study. Barium studies are needed for exact location of the tumour and in US negative cases.

Sensitivity of single and double contrast barium enema in the detection of colorectal carcinoma.

The preoperative barium enema of the 188 colorectal carcinoma patients operated at the Oulu University Central Hospital (Finland) during 1977-1982 were examined retrospectively. Altogether 112 single contrast studies and 87 double contrast studies had been made on these patients. The single contrast barium enemas had resulted in a correct diagnosis of colorectal carcinoma in 93 cases (sensitivity 83%). The correct diagnosis in the double contrast studies numbered 71 (sensitivity 82%). Most of the overlooked carcinomas were located in the caecum, in the sigmoid or the rectum. Most of the errors made in the single contrast studies were due to detection errors and poor evacuation. The most common failures in double contrast enemas were detection errors and nonvisualisation of the sigmoid. The authors recommend use of the double contrast technique and suggest that the two methods of barium enema be used to complement each other. A false negative diagnosis delayed the operation of the colorectal carcinoma patients by 2.2 months (median).