Small bowel enteroclysis

Plain film is indicated if obstruction or perforation is suspected. Meckel diverticulum is incidentally found by US (Fig. 5.14a), which may show cystic diverticula, andby enteroclysis. Small bowel or colon enemas can show the rather bigger diverticula. Scintigraphy may identify a Meckel diverticulum if it has gastric mucosa as a hot spot (Fig. 5.14b). 

Enteroclysis is used to evaluate the small bowel by introducing contrast agents by tube through the nose or mouth. 

FIGURE 31-2. Normal small bowel enteroclysis. Contrast agents are instilled into the small bowel to highlight tumors, strictures, or other lesions. In this image, one can identify the normal circular folds. 

Miller RE, Sellink JL. Enteroclysis The small bowel enema. How to succeed and how to fail. Gastrointest Radiol 1979 4 269-283. 

Fig. 5.23. a Enteroclysis in a boy with Crohn disease. The terminal ileum is affected and narrowed with prestenotic dilatation. There is an effacement of the mucosal pattern and septation of loops. Infiltration of the mesenteric fat causes isolation of the terminal ileum, b Crohn disease. CT demonstrates thickened small bowel up to distended cecum, c-e Child with Crohn disease. The US images show an irregular bowel wall thickening and a hyperechoic thickened mesentery... 

Whilst the barium follow through is the main contrast examination for assessing the small bowel in IBD (Fig. 6.16b) it may still provide information on the colon if delayed views are obtained however, the barium enema is mainly used in the colon. A double-contrast technique is necessary for mucosal delineation although for patients with advanced disease a single contrast study may be adequate. Some centers have a preference for performing small bowel enteroclysis. 

CT, fibrofatty proliferation shows a slightly increased attenuation. In MRl, the signal intensity is decreased compared with normal fat separating the bowel loops. Phlegmon and abscesses can occur in the small bowel mesentery, abdominal wall, or psoas muscle or perianally. They are well demonstrated on CT and fat-saturated TlW MR imaging [59]. Fistulas and sinus tracts are also depicted however, the reported sensitivity of MR imaging for depicting sinus tracts is 50%-75% compared to a conventional enteroclysis study [63]. 

Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M (2004) Assessment of Crohn s disease activity in the small bowel with MR and conventional enteroclysis preliminary results. Eur Radiol 14 1017-1024... 

Bodily KD, Fletcher JG, Solem CA et al (2006) Crohn disease mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation. Radiology 238 505-516 Boudiaf M, Jaff A, Soyer P et al (2004) Small-bowel diseases prospective evaluation of multidetector helical CT enteroclysis in 107 consecutive patients. Radiology 233 338-344... 

The technique of enteroclysis is considered the gold standard for the radiological investigation of small bowel disorders (Maglinte et al. 1996a Bender et al. 1999 Schmidt et al. 2005), since only volume challenges results in homogenous luminal distention, which is mandatory for the detection of intestinal diseases. 

Due to the ability of multidetector CT scanners to scan large volumes at faster speed with the ability to perform reconstruction following the examination, CT enteroclysis has become a more feasible extension of the conventional enteroclysis and CT methods of examining the small intestine. Using this technique, adequate luminal distention is mandatory because poorly distended loops can simulate disease or hide pathologic processes (Bender et al. 1999). In the past, inadequate small bowel luminal distention has necessitated nasojejunal intubation to infuse contrast material (Gore et al. 1996). 

An adequate small bowel distension is mandatory for an accurate study and it is obtained by using either oral contrast agent ( MR follow-through ) or naso-jejuneal catheter ( MR enteroclysis ). 

North JH, Pack MS (2000) Malignant tumors of the small intestine a review of 144 cases. Am Surg 66 46-51 Ominsky SH, Moss AA (1979) The postoperative stomach a comparative study of double-contrast barium examinations and endoscopy. Gastrointest Radiol 4 17-21 Orjollet-Lecoanet C, Menard Y, Martins A et al (2000) CT enteroclysis for detection of small bowel tumors. J Radiol 81 618-627... 

Fig. 5.16a-d. Coeliac disease a Small bowel barium follow-through shows loss of fold pattern and reduced number of folds in a patient with celiac disease, b Enteroclysis showing a completely featureless duodenum, so called Moulage sign. c,d Multiple strictures involving duodenum and jejunum in supine (c) and prone (d) position in a patient with advanced celiac disease. Images (c) and (d) courtesy of Dr. Peter Preston... 

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