Pickhardt Perry J
Department of Radiology, University of Wisconsin School of Medicine & Public Health, Clinical Science Center, Madison, 53792-3252, USA.
Abdom Imaging. 2012 Jun;37(3):313-25. doi: 10.1007/s00261-011-9766-1.
The peroral pneumocolon represents a time-honored but somewhat forgotten and underutilized technique for improved ileocecal evaluation at small bowel fluoroscopy. The peroral pneumocolon entails fluoroscopically guided gaseous insufflation per rectum following the arrival of barium at the cecum at conventional small bowel follow-through examination. In most cases, high-quality double contrast evaluation of the terminal ileum can be achieved, often superior to enteroclysis examination for this critical location. The peroral pneumocolon improves diagnostic confidence, including assessment of disease activity, and may result in a reversal of the diagnostic impression. This simple procedure will be discussed and a spectrum of fluoroscopic findings with CT and endoscopic correlation will be provided to demonstrate the added yield of this technique in the evaluation of known or suspected Crohn's disease. Application of the pneumocolon technique to CT for combined small and large bowel evaluation ("CT coloenterography") will also be discussed, which represents an attractive new option for investigating inflammatory bowel disease and other bowel-related conditions. Through the use of automated low-pressure carbon dioxide delivery per rectum, supplemented by IV glucagon for relaxation of the ileocecal valve, a CT-based pneumocolon examination may prove to be a useful hybrid technique for bowel evaluation in the future.
经口气钡双重对比结肠造影是一种历史悠久但有些被遗忘且未得到充分利用的技术，用于在小肠荧光透视检查中改善回盲部评估。经口气钡双重对比结肠造影是在传统小肠钡剂通过检查中钡剂到达盲肠后，在荧光透视引导下经直肠注入气体。在大多数情况下，可以实现对末端回肠的高质量双重对比评估，对于这个关键部位，其评估效果通常优于小肠灌肠检查。经口气钡双重对比结肠造影提高了诊断的可信度，包括对疾病活动度的评估，并且可能会改变诊断印象。本文将讨论这一简单操作，并提供一系列与CT和内镜检查结果相关的荧光透视表现，以证明该技术在已知或疑似克罗恩病评估中的额外价值。还将讨论气钡双重对比结肠造影技术在CT上用于小肠和大肠联合评估（“CT结肠小肠造影”）的应用，这是一种用于研究炎症性肠病和其他肠道相关疾病的有吸引力的新选择。通过经直肠自动输送低压二氧化碳，并辅以静脉注射胰高血糖素来松弛回盲瓣，基于CT的气钡双重对比结肠造影检查可能在未来成为一种有用的肠道评估混合技术。
