Abstract
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.
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References
Fitzgerald EJ, Thompson GT, Somers SS, Franic SF (1985) Pneumocolon as an aid to small-bowel studies. Clin Radiol 36:633–637
Heitzman ER, Berne AS (1961) Roentgen examination of the cecum and proximal ascending colon with ingested barium. Radiology 76:415–421
Kellett MJ, Zboralske FF, Margulis AR (1977) Per oral pneumocolon examination of the ileocecal region. Gastrointest Radiol 1:361–365
Kelvin FM, Gedgaudas RK, Thompson WM, Rice RP (1982) The peroral pneumocolon: its role in evaluating the terminal ileum. AJR Am J Roentgenol 139:115–121
Kressel HY, Evers KA, Glick SN, Laufer I, Herlinger H (1982) The peroral pneumocolon examination—technique and indications. Radiology 144:414–416
Margulis AR (1967) Some new approaches to examination of gastrointestinal tract. Am J Roentgenol Radium Ther Nucl Med 101:265–286
Minordi LM, Vecchioli A, Dinardo G, Bonomo L (2006) The value of the per oral pneumocolon in the study of the distal ileal loops. Clin Radiol 61:1016–1022
Wolf KJ, Goldberg HI, Wall SD, Rieth T, Walter EA (1985) Feasibility of the peroral pneumocolon in evaluating the ileocecal region. AJR Am J Roentgenol 145:1019–1024
Pickhardt PJ, Choi JR, Hwang I, et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200
Elsayes KM, Al-Hawary MM, Jagdish J, Ganesh HS, Platt JF (2010) CT enterography: principles, trends, and interpretation of findings. Radiographics 30:1955–1970
Paulsen SR, Huprich JE, Fletcher JG, et al. (2006) CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 26:641–658
Gellett LR, Farrow R, Bloor C, Farmer KD, Maskell GF (1999) Pain after small bowel meal and pneumocolon: a randomized controlled trial of carbon dioxide versus air insufflation. Clin Radiol 54:381–383
Shinners TJ, Pickhardt PJ, Taylor AJ, Jones DA, Olsen CH (2006) Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography. AJR Am J Roentgenol 186:1491–1496
Burling D, Taylor SA, Halligan S, et al. (2006) Automated insufflation of carbon dioxide for MDCT colonography: distension and patient experience compared with manual insufflation. AJR Am J Roentgenol 186:96–103
Deignan RW, Malone DE, Taylor S, et al. (1995) Improving visualization of distal and terminal ileum during the small bowel meal: an evaluation of fluoroscopic manoeuvres. Clin Radiol 50:548–552
Pickhardt PJ (2006) Utilization of the double-contrast barium enema in the early era of screening CT colonography. AJR Am J Roentgenol 187:W661
Ferrucci JT (2006) Double-contrast barium enema: use in practice and implications for CT colonography. AJR Am J Roentgenol 187:170–173
Stringer DA, Sherman P, Liu P, Daneman A (1986) Value of the peroral pneumocolon in children. AJR Am J Roentgenol 146:763–766
Minordi LM, Vecchioli A, Dinardo G, Bonomo L (2006) The value of the per oral pneumocolon in the study of the distal ileal loops. Clin Radiol 61:1016–1022
Ha AS, Levine MS, Rubesin SE, Laufer I, Herlinger H (2004) Radiographic examination of the small bowel: survey of practice patterns in the United States. Radiology 231:407–412
Wold PB, Fletcher JG, Johnson CD, Sandborn WJ (2003) Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology 229:275–281
Maglinte DDT (2006) CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases—invited commentary. Radiographics 26:659–663
Maglinte DDT, Sandrasegaran K, Lappas JC, Chiorean M (2007) CT enteroclysis. Radiology 245:661–671
Kohli MD, Maglinte DDT (2009) CT enteroclysis in small bowel Crohn’s disease. Eur J Radiol 69:398–403
Pickhardt PJ, Kim DH, Taylor AJ, et al. (2007) Extracolonic tumors of the gastrointestinal tract detected incidentally at screening CT colonography. Dis Colon Rectum 50:56–63
Pickhardt PJ (2007) Screening CT colonography: how I do it. AJR Am J Roentgenol 189:290–298
Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239:313–316
Gupta A, Postgate AJ, Burling D, et al. (2010) A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome. AJR Am J Roentgenol 195:108–116
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Pickhardt, P.J. The peroral pneumocolon revisited: a valuable fluoroscopic and CT technique for ileocecal evaluation. Abdom Imaging 37, 313–325 (2012). https://doi.org/10.1007/s00261-011-9766-1
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DOI: https://doi.org/10.1007/s00261-011-9766-1