Advanced Colorectal Carcinoma Missed by Radiology Shunkichi Kai 1 1Department of Internal Medicine, Cancer Institute Hospital Keyword: 大腸癌 , 注腸X線検査 , 見逃し , retrospective study pp.759-774
Published Date 1993/7/25
DOI https://doi.org/10.11477/mf.1403106210
  • Abstract
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 Retrospective review of the initial radiographic films was done to clarify the cause of oversight of advanced colorectal carcinoma, based on 14 cases which had been missed in the initial radiographic examination at the Cancer Institute Hospital in a period of 6 years from 1986 to 1991. Eleven missed cases were located in the right colon, and 3 were in the left colon.

 The most frequent causes of oversight were lumen contraction (spasm) and insufficient barium coating of the mucosa. Overlapping of the colon loop and bending, misjudgments were the next most frequent causes. Lumen contraction was observed in the cases for which antispasmodic agent was not used, and occurred most frequently in the transverse and left colon. Insufficient barium coating occurred in the ascending colon. This was caused by the dilution of barium due to the remaining fluid content in this location.

 The location of the missed lesion was recognized in 7 cases by the review of the initial radiographic films, and all of them were visualized as unilateral deformity (depressed sign) of various grades. It was not confirmed in the remaining 7 cases.

 Meticulous interpretation of radiographic films is required to avoid oversights, and the following points are considered to be of much importance to achieve this purpose. (1) The use of antispasmodics is mandatory, except in cases of contraindication, to minimize anxiety and tension of patients and obtain as well as optimal lumen distension. (2) Double contrast radiographs should be taken segmentally from the rectum to the proximal portion, and various positioning should be used for avoiding the overlapping of the loops. (3) Compression is recommended to make sure lesions are detected especially in the right and transverse colon, if possible. (4) A higher concentration of barium is to be used in cases in which, for various reasons, sufficient preparation of the patient may not have been made.

Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.


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