小腸の炎症性疾患診断におけるX線検査の有用性―小腸X線検査のポイント

Usefulness of Radiological Examination for Inflammatory Disease in the Small Intestine

要旨　小腸の諸X線検査に共通した基本手技は，①小腸索を分離して描出すること，②小腸索を低緊張状態にして圧迫，または二重造影法を行うことにある．したがって，体位変換と呼吸運動を利用して圧迫分離すること，遮断剤を適切に用いることが重要な手技となる．本稿では経口法，経管法など諸小腸X線検査法の手技を詳述し，炎症性腸疾患のX線検査では，①各検査法の利点，弱点を熟知した上で目的に応じた検査法を選択する必要があること，②瘻孔の存在が予想される場合は，抗生物質を混入した造影剤を投与する必要があることなどを述べた．さらに病態の解明には微細病変の診断を正確に行う必要があり，そのためには Peyer 板の診断の確立が不可欠であることを症例を提示して説明した．

　The principles involved in small-intestinal radiography are : (1) to visualize the small intestinal loops separately and (2) to investigate the small intestine in the hypotonic condition either by the barium-meal method with compression procedure or by the double-contrast method. Accordingly, the following techniques should be utilized, respectively : (1) Take the radiograph at the proper patient-position in which the loops become separated and at the proper phase of respiration of the patient, because respiration causes changes in the abdominal cavity and subsequently changes the extension of the intestine itself. (2) Administrate an anti-cholinergic agent intravenously.

　In this article, we described detailed techniques for radiography of the small intestine, such as the barium-meal method, the double contrast method using a single balloon tube etc. Furthermore, especially in radiological study for inflammatory bowel disease patients, we stressed the following important points : We should select which radiological technique is the most appropriate for the patient, based on an understanding of the advatages and disadvantages of each radiological method. In addition, barium that contains antibiotics should be prepared for cases in which fistula formation is expected to be present.

　On the other hand, for investigating the pathogenesis of inflammatory bowel disease in the small intestine, it is necessary to analyze minute or subtle lesions. For this purpose, the establishment of a diagnostic method to identify Peyer patches in small-intestinal radiography is indispensable. This necessity is shown in the case demonstrated in this article.