Diverticulitis x ray: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Diverticulitis}} | {{Diverticulitis}} | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}} {{AEL}} | ||
==Overview== | ==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== | ==X Ray== | ||
===Abdominal X ray=== | ===Abdominal X ray=== | ||
====Barium enema==== | ====Barium enema==== | ||
*X-ray barium enema is not the first diagnostic procedure to diagnose acute diverticulitis. However, it may be useful in case | *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.<ref name="pmid16741596">{{cite journal| author=Rafferty J, Shellito P, Hyman NH, Buie WD, Standards Committee of American Society of Colon and Rectal Surgeons| title=Practice parameters for sigmoid diverticulitis. | journal=Dis Colon Rectum | year= 2006 | volume= 49 | issue= 7 | pages= 939-44 | pmid=16741596 | doi=10.1007/s10350-006-0578-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16741596 }} </ref><ref name="pmid4093571">{{cite journal| author=Doris PE, Strauss RW| title=The expanded role of the barium enema in the evaluation of patients presenting with acute abdominal pain. | journal=J Emerg Med | year= 1985 | volume= 3 | issue= 2 | pages= 93-100 | pmid=4093571 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4093571 }} </ref><ref name="pmid8518890">{{cite journal| author=McKee RF, Deignan RW, Krukowski ZH| title=Radiological investigation in acute diverticulitis. | journal=Br J Surg | year= 1993 | volume= 80 | issue= 5 | pages= 560-5 | pmid=8518890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8518890 }} </ref><ref name="pmid6734062">{{cite journal| author=Hayward MW, Hayward C, Ennis WP, Roberts CJ| title=A pilot evaluation of radiography of the acute abdomen. | journal=Clin Radiol | year= 1984 | volume= 35 | issue= 4 | pages= 289-91 | pmid=6734062 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6734062 }} </ref> | ||
*Barium enema | *[[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 | **[[Enema]] [[rupture]], which may cause [[cellulitis]] and [[peritonitis]]. | ||
**If enema fails, it will delay other imaging procedures like CT scan, [[endoscopy]], and [[angiography]]. | |||
**If | **It may cause acute [[intestinal obstruction]]. | ||
**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]] | |||
[[Image:Webp.net-gifmaker (2).gif|500px|thumb|center|Air fluid levels and obstruction. Source:Dr Abdullah Alqudah, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.]] | |||
*The single contrast technique may be preferred over the double contrast technique in the following cases: | *The single contrast technique may be preferred over the double contrast technique in the following cases: | ||
**The patient is unable to turn quickly/effectively | **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 | **Evaluation for acute diverticulitis when CT is unavailable | ||
**Evaluation for acute diverticulitis when | **Evaluation for a colonic [[fistula]] | ||
** | |||
**Evaluation for postoperative leak after colon surgery | **Evaluation for postoperative leak after colon surgery | ||
*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 | **Patients with [[pneumoperitoneum]] shown in the chest X ray. | ||
**Patients who | **Patients who had a recent deep [[rectal]] [[biopsy]]. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WS}} | |||
{{WH}} | |||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 21:26, 29 July 2020
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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
.gif)
- 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.
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.