Enteroclysis

Sellink 's enteroclysis in Crohn's disease showing a stenosis in the ileum .

An enteroclysis (antegrade contrast enema, double- contrast examination of the small intestine according to Sellink ) according to Sellink or Antes is a double- contrast image of the small intestine using x-rays . It was described by JL Sellink in 1971 and has since largely replaced the previously common barium meal.

First, a positive contrast medium (CM) is brought to the duodenojejunal flexura (transition from the duodenum to the jejunum ) via a nasojejunal probe . The contrast agent consists of water-insoluble barium sulfate . A second, aqueous, negative contrast medium (methyl cellulose) is used to propel the barium sulfate column through the entire remaining small intestine . This double contrasting makes the intestinal lumen appear transparent, while the barium sulphate rests against the intestinal walls and these can be examined. The lumen width and the fold relief ( Kerckring folds ) are examined and filling defects, pad effects , distortions and distancing of the intestinal loops from one another as well as changes in the vicinity of the intestinal loops ( fistulas, etc.) and motility disorders (hyper- or hypomotility) are recorded. Furthermore, the intestinal wall thickness is assessed, which should not exceed 2 mm in the small intestine.

In addition to chronic inflammatory bowel diseases and their complications (fistulas, abscesses, bowel contortions and stenoses ), the indications for this examination also include mobility disorders, evidence of diverticula and the detection of tumorous wall changes.

The patient must be sober for the examination (no eating, drinking or smoking). According to Sellink, passage through the small intestine is contraindicated if an ileus is suspected , if paralysis or perforation is suspected, and 14 days before and after an abdominal operation. These contraindications are mainly derived from the choice of the contrast medium barium sulfate. If the insoluble barium sulfate were to get intraperitoneally (into the abdominal cavity), this would lead to a highly dangerous barium peritonitis , which - if it is survived at all - leaves massive adhesions between the intestine and peritoneum as well as the intestinal loops with one another with a corresponding impairment of intestinal peristalsis.

MRI enteroclysis

MR enteroclysis in Crohn's disease : Significant wall thickening and contrast medium uptake in the affected section of the intestine.

As an alternative to the classic enteroclysis, the MRI enteroclysis can now be used for many indications. Here, too, the small intestine is filled with a probe before the actual MRI examination. The advantages are the lack of radiation exposure during the examination itself (an X-ray control is usually used to place the probe in the duodenum) and the avoidance of barium in favor of other non-critical liquids. With the administration of intravenous contrast media, additional information such as B. to the degree of activity of an inflammation can be obtained.

See also

• Depending on the indication (e.g. when asked about ileus), a fractionated passage through the small intestine with a water-soluble, iodine-containing contrast agent may be advisable.

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1. ^ Reiser M. , Kuhn FP., Debus J. (2006) Dual Series - Radiology. Thieme
2. ↑ Herold internal medicine (2009), page 460
3. ↑ A. Stäbler, B. Ertl-Wagner (Ed.): Radiology trainer . Body trunk, internal organs and vessels. 1st edition. Thieme, Stuttgart 2005, ISBN 3-13-137051-3 , p. 226 ( preview [accessed November 21, 2011]).

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