小腸二重造影法の実際

The Double Contrast Method of the Small Bowel

　十二指腸まで挿入したゾンデから，造影剤と空気を直接小腸に注入して行う検査法（以下，二重造影法と言う）を，われわれが報告してから10年が経過した¹⁾．

　今では，この方法を使わなければ“小腸のX線検査をした”とは言えない．特に炎症性疾患に対しては不可欠となっている．われわれはルーチン検査にもこの方法を導入して，小腸病変の発見を試みている．

　二重造影法の実際のやり方とそのコツ，更にその欠点を補う新しい試みを述べる．

　Fine mucosal abnormalities can be more clearly demonstrated by the double contrast method with air than the barium thin layer method with water (Sel-link) or methylcellulose (Herlinger).

　In this paper, practice of the double contrast radiography including retrograde air injection technique and demonstrability of fine mucosal relief are described.

　1. Sequence of the double contrast method

　a) Spraying the throat with Lidocaine and inserting the tube (Bilbao-Dotter tube) to the 3rd portion of the duodenum near the duodeno-jejunal flexure,

　b) Slowly administrating about 400 ml of 60 W/V% barium suspension,

　c) Injecting air, after the top of the barium column reaches to the terminal ileum and filming the upper part of the small bowel during and immediately after air injection,

　d) Giving antispasmoidicus (Coliopan or Buscopan) when the lower part of the small bowel is filled enough with air,

　e) Filming the middle and lower parts of the small bowel.

　2. Demonstrability of fine mucosal relief by the double contrast method

　a) In the routine examination, good double contrast view of the upper and middle parts of the small bowel can be obtained nearly always, but difficulty often arises in obtaining the diagnostic double contrast view of the lower part of the small bowel due to overlap-ping of several intended loops, insufficient amount of air or poor mucosal coating.

　b) In the detailed examination, good double contrast view can be obtained at the every intentioned part of the small bowel.

　c) The double contrast method is best suited for visualizing small and fine mucosal abnormalities, but the segments with severe inflammatory lesion are some-times difficult to visualize by this method.

　3. Retrograde air injection technique for obtaining good double contrast view at the lower part of the small bowel

　a) Injecting antispasmoidicus after the top of the barium column, administrated per oral or through the tube, reaches to the ascending colon,

　b) Retrograde administration of air through the anal tube until the lower part of the small bowel is adequately distended.

　By this method, good double contrast picture at the lower part of the small bowel can be obtained.