Anomalies of the Colon: Their Roentgen Diagnosis and Clinical Significance

This study is based on a series of approximately 2,000 consecutive cases in which the form and function of the colon was observed roentgenologically. This series, in turn, constitutes a part of a basic group of approximately 4,000 private patients complaining of various digestive symptoms, thus furnishing a homogeneous background for the conclusions presented. The statistical method was employed throughout in the belief that this would yield results most likely to be objective in nature and most open to confirmation or refutat on by others. By way of preliminary survey 3,000 unselected cases of the basic group were analyzed for the general incidence of the more common symptoms of “indigestion.” These figures are presented in Table I, and will be used throughout the paper as a standard of comparison for the anomalies about to be described. Having no preconceived notions to establish, the chief emphasis will be placed on the facts themselves, leaving the temptation to speculate on their significance in the background. Nevertheless, before proceeding to details it may be of value to formulate the following generalizations that have grown out of this study: 1. Anomalies may be regarded as expressions of organic constitutional inferiority or, in other words, points of actual or potential weakness in the body structure. 2. Anomalies may be divided into the following three classes: Those incompatible with life (congenital atresia of the bile ducts); those compatible with life but not with robust health (high grade visceroptosis); those compatible with life and health under favorable circumstances (uncomplicated Meckel's diverticulum). 3. The general tendency seems to be for the body as a whole to compensate for the presence of an anomaly. Hence symptoms do not occur unless this compensatory mechanism breaks down, a break which may result from any of the following causes: a. Mechanical factors, such as strangulation of a silent Meckel's diverticulum. b. Infection, which may change a diverticulosis into a diverticulitis. c. Juxtaposition of two or more anomalies, such as the presence of ectopic gastric mucosa in a Meckel's diverticulum, which may lead to hemorrhage or perforation. d. Old age and increasing asthenia especially prominent in the case of all hernias and herniations, in which the weak spots exist from birth but the fully developed condition occurs later in life. e. Associated functional instability. When neuroses and anomalies co-exist, the former furnishes the underlying functional instability—the break in compensation—and the anomaly furnishes the particular digestive symptomatology for the clinical picture. 4. Because of variations in the compensatory mechanism, the symptomatology of anomalies is not continuous or progressive as in ordinary diseases.