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Radiology Of The Colon

Bambang Soeprijanto, dr., SpRad.


Medical Faculty
Airlangga University Surabaya

Radiology of The Colon


Barium Enema :
Colon Inloop
US Study :
CT Scan
MRI

Barium Enema
Methods :
1. Double contrast, the method of choice
to demonstrate mucosal pattern.
2. Single contrast, uses :
a. Children, since it is usually not necessary
to demonstrate mucosal pattern.
b. Reduction of an intussusception.

Indications :
1. Change in bowel habit.
2. Pain.
3. Mass.
4. Melaena.
5. Obstruction.
NB : If a tight stricture is demonstrated, only
run a small volume of barium proximally
the bariun may impact.

Contraindications :
Absolute :
1. Toxic megacolon.
2. Pseudomembranous colitis.
3. Rectal biopsy within the previous 3 days (it
is preferable to wait for 7 days).
Relative :
1. Incomplete bowel preparation.
2. Recent barium meal.

Contrast Medium :
Barium Sulfat (w/v. 500 ml for more, as
required).
Patient Preparation :
For 3 days prior to examination.
Low residue diet.
On the day prior to examination :
1. Fluids only.
2. Laxant (oral).
3. Dulcolax suppositoria.

On the day of the examination :


A colonic washout.
At least 1 hour must elapse before
starting the barium enema to allow time
for the colon to absorb the excess
water.
Preliminary film, Plain abdominal film :
a) To assess bowel preparation.
b) To exclude toxic megacolon.

Imaging And Lesion Of Hollow Organ

ABNORMAL RADIOLOGIC
FINDINGS OF THE COLON

Filling Defect in the caecum :


I.

Inflammatory process :

Appendicitis / abcess.
Tuberculosis infection.
Amoeboma.
Crohns disease.

Carcinoid tumor.

Adeno Ca.
Lympoma Ma.
Metastastic process.

intussusception

II. Benign neoplasms :

III. Malignant neoplasms :


IV. Miscellaneus :

Ulcerative lesions of the colon :


I. Infection process (colitis).
II. Malignancy process (primary or metastase).

Narrowing of the colon


I. Chronic infection.
II. Malignancy process.
III. Miscellaneus :

Inchaemia.
Adhesive band.
Radiation injury.

Large bowel obstruction :


I.

Volvunus
Intussusception (Invaginasi).
Adhesions.
II. Inflamatory strictures.
III. Malignancy process.
IV. Fecal impaction :

Meconeum plug syndrome.


Hirschsprungs disease.
Hernia.

Abnormal position of the colon


I.

Displacement, by :

intra abdominal masses


Extrinsic colon masses.

II. Abnormalities in rotation.


III. Hernia.

Abnormal diffuse dilatation of


the colon :
I. The cathartic colon.
II. Idiopathic megacolon :

Functional.
Neurogenic.

III. Due to low obstruction (imperforate


anus, Ca., etc).
IV. - Reflex ileus, paralytic ileus.
- Electrolyte imbalance.

ASSESSEMENT IN
DIAGNOSTIK IMAGING OF
COLON

CONSTIPATION

Adult

Child

Rectal examination,
Proctosigmoidoscopy

Barium Enema

Negative

Positive for local disease

Barium Enema

Treat

Negative

Colonoscopy

Positive for cancer,


polyp(s) or other abnormality

CHRONIC DIARRHEA

Clinical assessment of cause

Pancreatic or
small bowel
cause suspected

Colonic cause suspected

Barium Enema
to detect mass /
mucosal abnormality

Colonoscopy

Treat

ABDOMINAL PAIN

Supine and upright abdominal films


Upright chest film

Positive for free air,


Bowel obstruction, or
Extra-abdominal disease
(pp 32, 104, 108)
Treat

Negative for free air,


Bowel obstruction, or
Extra-abdominal disease

Evaluate patient for other


Causes of abdominal pain

Acute abdomen
Non acute abdomen

Upper GI pain

Lower GI pain

Barium Enema

Suspected Bowel Obstruction


Supine and upright
abdominal films
upright PA chest film
Assess abdominal and chest films

No radiographic
evidence of obstruction

Possible evidence of
bowel obstruction

Follow-up films
In several hours;
Clinical reassessment

Definite evidence of
bowel obstruction

Patient
critically ill

Probable small
bowel obstruction

Probable colon
obstruction

Explorative
Surgery

Upper GI Series;
Small Bowel Study

Barium Enema

Suspected
ABDOMINAL MASS
Assess history and physical examination
or previous imaging procedure(s)

Nonpregnant adult
Nonpulsatile mass

Pulsatile mass,
Possible aneurysm

Pregnant
patient

Infant or Child

Plain film
examination

Ultrasonography
Ultrasonography

Plain ABDOMINAL
X-RAYS

Unsatisfactory
examination
Aneurysm
demonstrated

Normal
Suspected Colon,
Distal Small Bowel
Obstruction
Barium Enema

Obstruction Strongly
Suspected Clinically

Suspected Gastric
Duodenal, Small
Bowel Obstruction
UGI Study

Mass satisfactorily
delineated

Treat