Complete Reflux Small Bowel Examination

The Many different methods of small bowel examination recorded in the literature indicate that these are not as rapid or as exact as we would like (1–19). While the radiographic study of the colon and stomach is highly accurate when performed by competent examiners, the antegrade small bowel examination lacks this precision. For example, tumors of the small bowel are frequently not discovered until obstruction or other symptoms force an exploratory laparotomy. Most physicians hope for some improvement in this area, and we believe the complete reflux small bowel examination is a step forward. In our experience this new procedure is easier, quicker, and more fruitful than the older methods. This new method has demonstrated small ulcerations and inflammatory strictures of the small bowel as well as several other complete and incomplete obstructions: Meckel's diverticula (one inverted), a radiolucent gallstone causing obstruction, adhesive bands, small bowel fistulae, and the extent of disease in regional enteritis. In addition, extrinsic tumors (both primary and metastatic) causing partial obstruction have been diagnosed and accurately localized, and obstructive has been differentiated from nonobstructive acute abdominal disease. In almost all in stances the antegrade study failed to show these conditions, all of which were proved by surgery. While more lesions have been discovered in the ileum because of a higher incidence here, some have also been demonstrated in the proximal jejunum. Unfortunately, this new method will not completely replace others, but it does offer fast and accurate diagnosis of small bowel lesions in a great number of cases. Disadvantages of Follow-Through Examinations In small bowel “follow-through” examinations intestinal filling is governed by an unpredictable rate of delivery through the pylorus. This produces intermittent, irregular, and incomplete filling that may be further complicated by bowel irritability. This lack of complete filling and inability to test the elasticity of the bowel wall is the most severe limitation of the “follow-through” method. In the usual examination the maximum diameter of the bowel lumen is determined by peristalsis and the tone prevailing at the moment of film exposure, and early lesions with minimal constriction or small destructive ones of the mucous membrane may not be detectable.