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 | *X-ray [[barium enema]] is not the first choice diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case CT 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 | *[[Barium enema]] has been used in the diagnosis of acute diverticulitis, but is 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]], which may cause [[cellulitis]] and [[peritonitis]]. | ||
**If failed, it will delay other imaging procedures like CT scan, [[endoscopy]], and [[angiography]]. | |||
**If failed, it will | |||
**It may cause acute [[intestinal obstruction]]. | **It may cause acute [[intestinal obstruction]]. | ||
*The radiological findings in the abdominal | *The radiological findings in the abdominal X-ray include the following: | ||
** | **[[Intestinal obstruction]] | ||
**Multiple air-fluid levels in case [[perforation]] | **Multiple air-fluid levels in the case of [[perforation]] | ||
[[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]] | ||
*The single contrast technique may be preferred over the double contrast technique in the following cases: | *The single contrast technique may be preferred over the double contrast technique in the following cases: | ||
**The patient is unable to turn quickly/effectively | **The patient is unable to turn quickly/effectively since the double contrast technique requires rapid changes in patient position | ||
**When only the position and length of a structure is required | |||
**When only the position and length of a structure is required | **Evaluation for acute diverticulitis when the CT is unavailable | ||
**Evaluation for acute diverticulitis when the CT is unavailable | **Evaluation 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> | ||
| Line 35: | Line 33: | ||
[[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=== | ||
* | *A small percentage (about 27-33%) of the [[acute abdomen]] patients, including diverticulitis patients, 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]] | *Chest X-ray in cases of diverticulitis could show [[pneumoperitoneum]], gas within the [[peritoneal cavity]], which is often a harbinger of a critical [[illness]]. Discovering this abnormality will lead to change in the case management and the chest X-ray is the best radiological-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 20:07, 4 August 2017
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Diverticulitis x ray On the Web |
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American Roentgen Ray Society Images of Diverticulitis x ray |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
On abdominal X-ray, diverticulitis is characterized by multiple air and fluid levels if there is an intestinal perforation. Chest X-ray should be done in patients with diverticulitis to investigate for pneumoperitoneum, which is a harbinger of a critical illness and will lead to a change in the management plan for the case. X-ray can be used if CT is not available and in uncomplicated cases.
X Ray
Abdominal X ray
Barium enema
- X-ray barium enema is not the first choice diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case CT is not available.[1][2][3][4]
- Barium enema has been used in the diagnosis of acute diverticulitis, but is not the best procedure to diagnose the disease. Enema has many disadvantages which include:[5]
- Enema rupture, which may cause cellulitis and peritonitis.
- If failed, it will delay other imaging procedures like CT scan, endoscopy, and angiography.
- It may cause acute intestinal obstruction.
- The radiological findings in the abdominal X-ray include the following:
- Intestinal obstruction
- Multiple air-fluid levels in the case of perforation
- The single contrast technique may be preferred over the double contrast technique in the following cases:
- The patient is unable to turn quickly/effectively since the double contrast technique requires rapid changes in patient position
- When only the position and length of a structure is required
- Evaluation for acute diverticulitis when the CT is unavailable
- Evaluation 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
- A small percentage (about 27-33%) of the acute abdomen patients, including diverticulitis patients, 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, gas within the peritoneal cavity, which is often a harbinger of a critical illness. Discovering this abnormality will lead to change in the case management and the chest X-ray is the best radiological-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.