Mesenteric Angiography in the Evaluation of Inflammatory and Neoplastic Disease of the Intestine

Abstract

The Role of mesenteric angiography has not yet been defined in the investigation of inflammatory or neoplastic disease of the intestines. The angiographically demonstrated cases which have been published are too few to permit conclusions about the diagnostic potential of the method (1, 2, 4, 6, 8, 9–11, 15, 16). It has not been shown if benign tumors can be distinguished from the malignant, or if tumors can be differentiated from inflammatory disease. Microangiography has shown that differences exist in the vascular patterns of different intestinal lesions (14). The detail that can be achieved with this technic, however, is impossible to obtain by percutaneous angiography. Serial angiography, on the other hand, yields more information about the pathophysiologic changes. To assess the usefulness of present angiographic technics, we have evaluated the angiographic findings in 61 patients with histologically proved intestinal neoplastic or inflammatory lesions. These patients have been investigated at the University Hospital of Lund since 1959. Materials and Methods Selective mesenteric angiography has been performed in 39 patients with intestinal tumors and in 22 with inflammatory disease of the intestine. Ten tumors were in the small bowel (1 duodenum, 6 jejunum, and 3 ileum), and 29 were in the colon (6 cecum, 7 ascending colon, 4 transverse colon, 4 descending colon, 4 sigmoid colon, and 4 rectum). Of the inflammatory lesions, 7 were ulcerative colitis, 11 regional enteritis, 3 diverticulitis, and 1 appendiceal abscess. In 2 of the 11 patients with regional enteritis, the disease involved the colon. Lesions in the rectum, sigmoid colon, and descending colon were examined by inferior mesenteric angiography; those in the cecum, ascending colon, and right transverse colon, by superior mesenteric angiography. Left transverse colon lesions were examined by both methods. Catheterizations were performed with the percutaneous technic via the femoral arteries, with either a KIFA red catheter (I.D.∕O.D. = 1.2∕2.2) or a thin-walled KIFA red catheter (I.D.∕O.D. = 1.45∕2.2). Filming was done with a rapid roll-film changer, two exposures per second for five seconds, one per second for five seconds, and then one every other second for ten seconds. For the superior mesenteric studies, 30 cc 76 per cent Urografin (Schering, Germany), was used, for the inferior mesenteric studies 10–15 cc of 60 per cent. Injections were made with a pressure injector at approximately 10 cc per second. In 30 patients the colon was distended with air prior to the injection of the medium. Angiographic Findings 1. Inflammatory Lesions Ten of the 11 patients with regional enteritis had increased vascularity in the diseased segment, with slight dilatation of the supplying arteries and draining veins (Fig. 1).