Roentgenologic Study of the Small Intestine

Abstract

No physician can long engage in the practice of medicine without becoming impressed by the fact that complaints variously related to the alimentary tract are commonplace and diverse. More often than not, when radiologic consultation is arranged, no convincing explanation for the patient's symptoms is manifest at the fluoroscope or in supplementary roentgenograms. It has been the uniform experience of many radiologic groups who examine large numbers of persons each year, in search of demonstrable signs of gastro-intestinal disease, that dependable x-ray evidence of significant abnormality is to be expected in no more than 25 to 30 per cent of all patients whose digestive complaints have brought them to the radiologist for diagnostic consultation. In most of the cases where no abnormality can be found, the presenting symptoms are of such a nature that it is sufficient for the radiologic examination merely to exclude unlikely lesions. In other cases, however, there may be persistent, annoying, and even incapacitating symptoms arising from abnormalities which routine procedures may fail to uncover. Negative reports from the roentgenologist often result in lost opportunities for therapy. Harm may follow the all too frequent impeachment of the patient's psychiatric integrity. Gross pathologic lesions of the esophagus, the stomach, and the colon are recognizable with a high degree of accuracy by able roentgenologists with or without the advantage of leading clinical information. In other words, if digestive tract symptoms are produced by such lesions as peptic ulcer, gastric or colonic neoplasms, ulcerative colitis, and the like, recognition and accurate diagnosis of the underlying cause of the patient's complaints may be anticipated with reasonable confidence on the basis of x-ray findings. Disorders of the small intestine, on the other hand, producing motor or absorptive disturbances, will be as consistently overlooked unless clinical acumen is exercised and diagnostic efforts are properly directed. Ordinarily employed procedures in the roentgenologic search for alimentary tract disease are centered to an overwhelming degree upon the proximal three feet and the distal five feet of the tube, those portions which experience has taught harbor the great bulk of x-ray recognizable abnormalities. By and large, the longest portion of the gastro-intestinal tract, beginning at about the ligament of Treitz and extending to a point within 12 to 18 inches of the cecal junction, is scrutinized, if at all, in a most desultory fashion by most of us who are engaged in gastro-intestinal diagnosis. It is necessary to bear in mind that, despite its many and spectacular achievements as a demonstrator of disease processes, the x-ray approach to diagnosis is by no means omnipotent.