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*[[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> | *[[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]], which may cause [[cellulitis]] and [[peritonitis]]. | **[[Enema]] [[rupture]], which may cause [[cellulitis]] and [[peritonitis]]. | ||
**If | **If enema fails, it will delay other imaging procedures like CT scan, [[endoscopy]], and [[angiography]]. | ||
**It may cause acute [[intestinal obstruction]]. | **It may cause acute [[intestinal obstruction]]. | ||
*The radiological findings in the abdominal X-ray include the following: | *The radiological findings in the abdominal X-ray include the following: | ||
| Line 23: | Line 23: | ||
**The patient is unable to turn quickly/effectively since the double contrast technique requires rapid changes in patient position | **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 | **Evaluation for acute diverticulitis when CT is unavailable | ||
**Evaluation for a colonic [[fistula]] | **Evaluation for a colonic [[fistula]] | ||
**Evaluation for postoperative leak after colon surgery | **Evaluation for postoperative leak after colon surgery | ||
| Line 29: | Line 29: | ||
*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 [[pneumoperitoneum]] shown in the chest X ray. | **Patients with [[pneumoperitoneum]] shown in the chest X ray. | ||
**Patients who | **Patients who had 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=== | ||
*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 | *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 to have 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]].<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]], 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 20:11, 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 enema fails, 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 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 had 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 to have 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.