Diverticulitis x ray: Difference between revisions
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===Abdominal X ray=== | ===Abdominal X ray=== | ||
====Barium enema==== | ====Barium enema==== | ||
*X-ray barium enema is not the first diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case the CT scan is not available.<ref name="pmid16741596">{{cite journal| author=Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons| title=Practice parameters for sigmoid diverticulitis. | journal=Dis Colon Rectum | year= 2006 | volume= 49 | issue= 7 | pages= 939-44 | pmid=16741596 | doi=10.1007/s10350-006-0578-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16741596 }} </ref><ref name="pmid4093571">{{cite journal| author=Doris PE, Strauss RW| title=The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain. | journal=J Emerg Med | year= 1985 | volume= 3 | issue= 2 | pages= 93-100 | pmid=4093571 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4093571 }} </ref><ref name="pmid8518890">{{cite journal| author=McKee RF, Deignan RW, Krukowski ZH| title=Radiological investigation in acute diverticulitis. | journal=Br J Surg | year= 1993 | volume= 80 | issue= 5 | pages= 560-5 | pmid=8518890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8518890 }} </ref><ref name="pmid6734062">{{cite journal| author=Hayward MW, Hayward C, Ennis WP, Roberts CJ| title=A pilot evaluation of radiography of the acute abdomen. | journal=Clin Radiol | year= 1984 | volume= 35 | issue= 4 | pages= 289-91 | pmid=6734062 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6734062 }} </ref> | *X-ray [[barium enema]] is not the first diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case the CT scan is not available.<ref name="pmid16741596">{{cite journal| author=Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons| title=Practice parameters for sigmoid diverticulitis. | journal=Dis Colon Rectum | year= 2006 | volume= 49 | issue= 7 | pages= 939-44 | pmid=16741596 | doi=10.1007/s10350-006-0578-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16741596 }} </ref><ref name="pmid4093571">{{cite journal| author=Doris PE, Strauss RW| title=The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain. | journal=J Emerg Med | year= 1985 | volume= 3 | issue= 2 | pages= 93-100 | pmid=4093571 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4093571 }} </ref><ref name="pmid8518890">{{cite journal| author=McKee RF, Deignan RW, Krukowski ZH| title=Radiological investigation in acute diverticulitis. | journal=Br J Surg | year= 1993 | volume= 80 | issue= 5 | pages= 560-5 | pmid=8518890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8518890 }} </ref><ref name="pmid6734062">{{cite journal| author=Hayward MW, Hayward C, Ennis WP, Roberts CJ| title=A pilot evaluation of radiography of the acute abdomen. | journal=Clin Radiol | year= 1984 | volume= 35 | issue= 4 | pages= 289-91 | pmid=6734062 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6734062 }} </ref> | ||
*Barium enema was being used in diagnosis of acute diverticulitis but it was not the best procedure to diagnose the disease. Enema has many disadvantages which include:<ref name="pmid6697835">{{cite journal| author=Gottesman L, Zevon SJ, Brabbee GW, Dailey T, Wichern WA| title=The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis. | journal=Dis Colon Rectum | year= 1984 | volume= 27 | issue= 2 | pages= 84-8 | pmid=6697835 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6697835 }} </ref> | *Barium enema was being used in diagnosis of acute diverticulitis but it was not the best procedure to diagnose the [[disease]]. [[Enema]] has many disadvantages which include:<ref name="pmid6697835">{{cite journal| author=Gottesman L, Zevon SJ, Brabbee GW, Dailey T, Wichern WA| title=The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis. | journal=Dis Colon Rectum | year= 1984 | volume= 27 | issue= 2 | pages= 84-8 | pmid=6697835 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6697835 }} </ref> | ||
**Enema rupture | **[[Enema]] [[rupture]] | ||
**This rupture may cause cellulitis and peritonitis. | **This rupture may cause [[cellulitis]] and [[peritonitis]]. | ||
**If failed, it will lead to the delay of the other imaging procedures like CT scan, endoscopy and angiography to be held. | **If failed, it will lead to the delay of the other imaging procedures like CT scan, [[endoscopy]] and [[angiography]] to be held. | ||
**It may cause acute intestinal obstruction. | **It may cause acute [[intestinal obstruction]]. | ||
*The radiological findings in the abdominal x ray includes the following: | *The radiological findings in the abdominal x ray includes the following: | ||
**It shows intestinal obstruction | **It shows intestinal obstruction | ||
**Multiple air and fluid levels in case perforation occurs. | **Multiple air and fluid levels in case [[perforation]] occurs. | ||
[[Image:866011f1abdb744127ddd20d04acff jumbo.jpeg|centre|500px]] | [[Image:866011f1abdb744127ddd20d04acff jumbo.jpeg|centre|500px]] | ||
[[Image:Diverticulitis abdominal x ray.jpeg|centre|500px]] | [[Image:Diverticulitis abdominal x ray.jpeg|centre|500px]] | ||
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**When only the position and length of a stricture is required | **When only the position and length of a stricture is required | ||
**Evaluation for acute diverticulitis when the CT is unavailable for whatever reason) | **Evaluation for acute diverticulitis when the CT is unavailable for whatever reason) | ||
**Evaluating for a colonic fistula | **Evaluating for a colonic [[fistula]] | ||
**Evaluation for postoperative leak after colon surgery | **Evaluation for postoperative leak after colon surgery | ||
*Contraindications of the barium enema include the following:<ref name="pmid7122864">{{cite journal| author=Harned RK, Consigny PM, Cooper NB, Williams SM, Woltjen AJ| title=Barium enema examination following biopsy of the rectum or colon. | journal=Radiology | year= 1982 | volume= 145 | issue= 1 | pages= 11-6 | pmid=7122864 | doi=10.1148/radiology.145.1.7122864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7122864 }} </ref> | *Contraindications of the barium enema include the following:<ref name="pmid7122864">{{cite journal| author=Harned RK, Consigny PM, Cooper NB, Williams SM, Woltjen AJ| title=Barium enema examination following biopsy of the rectum or colon. | journal=Radiology | year= 1982 | volume= 145 | issue= 1 | pages= 11-6 | pmid=7122864 | doi=10.1148/radiology.145.1.7122864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7122864 }} </ref> | ||
**Patients with | **Patients with [[pneumoperitoneum]] shown in the chest X ray. | ||
**Patients who did a recent deep rectal biopsy. | **Patients who did a recent deep [[rectal]] [[biopsy]]. | ||
[[Image:Colonic-diverticulosis-on-single-and-double-contrast-barium-enema.jpg|centre|500px]] | [[Image:Colonic-diverticulosis-on-single-and-double-contrast-barium-enema.jpg|centre|500px]] | ||
===Chest X ray=== | ===Chest X ray=== | ||
*In small percentage (about 27-33%) of the acute abdomen patients, including diverticulitis, they may have a respiratory abnormality. Hence, chest x ray is recommended in patients suspected with diverticulitis. | *In small percentage (about 27-33%) of the [[acute abdomen]] patients, including diverticulitis, they may have a respiratory abnormality. Hence, chest x ray is recommended in patients suspected with diverticulitis. | ||
*Chest X ray in cases of diverticulitis could show pneumoperitoneum which is a gas within the peritoneal cavity, and is often the harbinger of a critical illness. Discovering this abnormality will lead to change in the case manangement and the chest X ray is the best radio-modality which can show the pneumoperitoneum.<ref name="pmid3924315">{{cite journal| author=Field S, Guy PJ, Upsdell SM, Scourfield AE| title=The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned? | journal=Br Med J (Clin Res Ed) | year= 1985 | volume= 290 | issue= 6486 | pages= 1934-6 | pmid=3924315 | doi= | pmc=1416036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3924315 }} </ref> | *Chest X ray in cases of diverticulitis could show [[pneumoperitoneum]] which is a gas within the [[peritoneal cavity]], and is often the harbinger of a critical illness. Discovering this abnormality will lead to change in the case manangement and the chest X ray is the best radio-modality which can show the pneumoperitoneum.<ref name="pmid3924315">{{cite journal| author=Field S, Guy PJ, Upsdell SM, Scourfield AE| title=The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned? | journal=Br Med J (Clin Res Ed) | year= 1985 | volume= 290 | issue= 6486 | pages= 1934-6 | pmid=3924315 | doi= | pmc=1416036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3924315 }} </ref> | ||
[[Image:Pneumoperitoneum-1.jpg|centre|500px]] | [[Image:Pneumoperitoneum-1.jpg|centre|500px]] | ||
Revision as of 19:47, 14 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
X ray is a supportive diagnostic modality to diverticulitis although it is not the best modality. It can be used in case the CT scan is not available and in the uncomplicated cases. The radiographies used are the abdominal x ray, barium enema and the chest x-ray. The barium enema has disadvantages as if rupture happens, it will cause peritonitis. Abdominal x-ray shows multiple air and fluid levels in case of intestinal perforation. Chest x-ray is important to be done in patients with diverticulitis to investigate for the pneumoperitoneum which is a harbinger to a critical illness and will lead to change in the management plan in the case.
X Ray
Abdominal X ray
Barium enema
- X-ray barium enema is not the first diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case the CT scan is not available.[1][2][3][4]
- Barium enema was being used in diagnosis of acute diverticulitis but it was not the best procedure to diagnose the disease. Enema has many disadvantages which include:[5]
- Enema rupture
- This rupture may cause cellulitis and peritonitis.
- If failed, it will lead to the delay of the other imaging procedures like CT scan, endoscopy and angiography to be held.
- It may cause acute intestinal obstruction.
- The radiological findings in the abdominal x ray includes the following:
- It shows intestinal obstruction
- Multiple air and fluid levels in case perforation occurs.
- The single contrast technique may be preferred over the double contrast technique in the following cases:
- The patient is unable to turn quickly/effectively
- Double contrast technique requires rapid changes in patient position
- When only the position and length of a stricture is required
- Evaluation for acute diverticulitis when the CT is unavailable for whatever reason)
- Evaluating for a colonic fistula
- Evaluation for postoperative leak after colon surgery
- Contraindications of the barium enema include the following:[6]
- Patients with pneumoperitoneum shown in the chest X ray.
- Patients who did a recent deep rectal biopsy.
Chest X ray
- In small percentage (about 27-33%) of the acute abdomen patients, including diverticulitis, they may have a respiratory abnormality. Hence, chest x ray is recommended in patients suspected with diverticulitis.
- Chest X ray in cases of diverticulitis could show pneumoperitoneum which is a gas within the peritoneal cavity, and is often the harbinger of a critical illness. Discovering this abnormality will lead to change in the case manangement and the chest X ray is the best radio-modality which can show the pneumoperitoneum.[7]
References
- ↑ Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons (2006). "Practice parameters for sigmoid diverticulitis". Dis Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.
- ↑ Doris PE, Strauss RW (1985). "The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain". J Emerg Med. 3 (2): 93–100. PMID 4093571.
- ↑ McKee RF, Deignan RW, Krukowski ZH (1993). "Radiological investigation in acute diverticulitis". Br J Surg. 80 (5): 560–5. PMID 8518890.
- ↑ Hayward MW, Hayward C, Ennis WP, Roberts CJ (1984). "A pilot evaluation of radiography of the acute abdomen". Clin Radiol. 35 (4): 289–91. PMID 6734062.
- ↑ Gottesman L, Zevon SJ, Brabbee GW, Dailey T, Wichern WA (1984). "The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis". Dis Colon Rectum. 27 (2): 84–8. PMID 6697835.
- ↑ Harned RK, Consigny PM, Cooper NB, Williams SM, Woltjen AJ (1982). "Barium enema examination following biopsy of the rectum or colon". Radiology. 145 (1): 11–6. doi:10.1148/radiology.145.1.7122864. PMID 7122864.
- ↑ Field S, Guy PJ, Upsdell SM, Scourfield AE (1985). "The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned?". Br Med J (Clin Res Ed). 290 (6486): 1934–6. PMC 1416036. PMID 3924315.