The value of the per oral pneumocolon in the study of the distal ileal loops

Aim

To verify the diagnostic accuracy of per oral pneumocolon in the identification of both normal and pathological patterns in patients with suspected or proven small bowel disease.

Materials and methods

Per oral pneumocolon was performed after small bowel follow-through examinations in a series of 42 selected patients. The terminal ileum visibility, the loop location and possible pathological patterns were evaluated separately before and after insufflation. In post-insufflation images the presence/absence of reflux and grade of reflux were evaluated.

Results

The diagnostic quality of per oral pneumocolon as compared with per oral small bowel examination was superior in 23 of the 42 patients (54.8%; group 1), similar in nine of the 42 (21.4%; group 2), and inferior in 10 of the 42 (23.8%; group 3). Transvalvular reflux was present in 22 of 23 (95.6%) patients from group 1 and only in one of 10 patients (10%) from group 3 (p<0.001: statistically significant difference). Among the 24 of 42 (57.1%) patients with suspected or proven Crohn's disease, per oral pneumocolon increased the confidence with which the ileum was considered normal in 12 patients and it allowed a better evaluation of the disease extent and the differentiation between prolonged spasms and stenosis in five patients.

Conclusion

In conclusion per oral pneumocolon should be performed after a small bowel follow-through examination in selected patients.