1. Practical radiology of the small and large intestine
Prepared by Dr Sarah Kamal
Radiology lecturer
اسم ورقم المقرر – Course Name and No.
5/6/2019

2. By the end of this lecture, the student should be able to:
Learning objectives
By the end of this lecture, the student should be able to:
Describe radiological anatomy of the small and large intestine
Mention different imaging modalities used to assess medical conditions of both the small and the large intestine
Describe the radiological features of some common pathological conditions affecting this region.
اسم ورقم المقرر – Course Name and No.
5/6/2019

3. 2 1 3 4
Plain x-ray abdomen and pelvis AP view

4. Plain x-ray abdomen and pelvis AP view
Transverse colon
stomach
cecum
Descending colon
Plain x-ray abdomen and pelvis AP view

5. Large vs small bowel Large bowel Small bowel
Peripheral (except RUQ occupied by liver)
Haustral markings don’t extend from wall to wall
Small bowel
Central
Valvulae conniventes extend across lumen and are spaced closer together

6. Comparison of large and small bowel
Valvulae conniventes: extend across lumen and are spaced closer together
Many loops
Centrally placed
3-5cm
اسم ورقم المقرر – Course Name and No.
5/6/2019

7. •Peripheral distribution •>5cm
Large bowel
•Haustra: Haustral markings don’t extend from wall to wall
•Fewer loops
•Peripheral distribution
•>5cm
اسم ورقم المقرر – Course Name and No.
5/6/2019

8. Plain x-ray abdomen AP view
اسم ورقم المقرر – Course Name and No.
5/6/2019

9. TECHNIQUE
1. SINGLE CONTRAST STUDY
2. DOUBLE CONTRAST STUDY

10. •There are two varieties of barium study: single and double contrast meals.
•A single contrast study uses only barium, a radioopaque (or positive) contrast medium, to image the upper gastrointestinal tract.
•A double contrast study uses barium as well as a radiolucent (or negative) contrast medium such as air, nitrogen, or carbon dioxide.
•The double contrast meal is more useful as a diagnostic test, demonstrating mucosal details and allowing the detection of small mucosal lesions such as diverticula or polyps.
اسم ورقم المقرر – Course Name and No.
5/6/2019

12. Barium Studies of the GI Tract
Barium enema

13. 4 5 6 3 7 2 8 1

14. Rectum Sigmoid colon Descending colon Splenic flexure Transverse colon
Barium enema double contrast study 4 5 6
Rectum
Sigmoid colon
Descending colon
Splenic flexure
Transverse colon
Hepatic flexure
Ascending colon
cecum 3 7 2 8 1

15. 5 2 1 6 4 3
CT Abdomen axial with contrast

16. 5 2 1 6 4 3
1- Rectum 2-Sigmoid colon 3-Descending colon 4-Ascending colon 5-Transverse colon 6-Cecum
CT Abdomen axial with contrast

17. 3 2 4 1 5 6
CT Abdomen reformatted with contrast

18. Double contrast study with features of an outpouching mass from the large intestinal wall into the lumen suggesting Polyp A B

19. Is this study normal or abnormal? And why?
Abnormal barium enema
Showing narrowing in the intestinal wall with shouldering suggesting Colon Cancer (apple core sign)

20. Colonic Carcinoma Annular Carcinoma with shelf-like margin
Barium enema
Annular Carcinoma with shelf-like margin

21. Lead pipe colon Shortening of colon secondary to fibrosis
Loss of haustration
Ulcerative colitis

22. Ulcerative colitis
Feature-less colon(lead pipe appearance)

23. NORMAL
What is the diagnosis?

24. Barium enema
Sigmoid cancer

25. Small bowel imaging

26. Small bowel imaging
The small intestine is one of the most difficult areas to study radio graphically in the gastro-intestinal tract; yet,
satisfactory examinations are needed to give the maximum definition of every inch of the intestine .

27. Barium Studies of the GI Tract
Small bowel follow-through
The passage of the barium through the esophagus, stomach, and small intestine is monitored on the fluoroscope.
The test usually takes around three to six hours.

28. اسم ورقم المقرر – Course Name and No.
5/6/2019

29. Mechanical Small bowel obstruction
Dilated small bowel
Fighting loops (visible loops, lying transversely, with air-fluid levels at different levels)
Little gas in colon, especially rectum

30. Plain x-ray Abdomen AP view with multiple air fluid levels suggesting Small bowel obstruction

31. Thank you
اسم ورقم المقرر – Course Name and No.
5/6/2019