VOL.

101,

No.

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COLONIC

ILEUS
AND
ROENTGEN

DAVID

By

BRYK,

and

M.D.,t
BROOKLYN,

OLONIC
or

colonic

cumulative

of

must

be

plain

roentgenogram

of

recognized

colonic

acute

that

ileus

largely

have

the

colonic

inadequate.

stated

colonic

the

tion
was undertaken
with
on the plain
roentgenogram

AND

cholecystitis2

3.

Acute

gastroenteritis2

4.

Acute

pancreatitis22#{176}

OF

of

9.

that
that

the
colonic

blocking

thrombosis

Morphine

overdosage2

Myxedema

13.

Parkinsons
disease
(especially
on anti-Parkinsons medications)4
Pelvic or extraperitoneal
infection

i6.

Porphyria2

17.

Psychosis24

i8.

Pulmonary

19.

Renal

20.
2!.

Sepsis16
Surgery,

22.

Trauma

3.

Urinary

embolism

failure2125

especially

pelvic

tinuity

the
As

calculus2

this

reason

the

Department

of Radiology,

Formerly
Associate
Director
Medical
Center
of Brooklyn.

Assistant

Radiologist,

Maimonides

of Radiology,

Maimonides

Medical

Medical

and

329

contour

of the

septa;
amount
retained
fluid;

appearance

of

the

of these roentgen

application

of

which

we

significance

Brooklyn,

New

presently

had
and

the various
based
upon

and
and

retained

criteria

experience
in the
diagnosis
of
ileus
during
the past
few years.
favorable
results
were
obtained
by

Center;

of
was

thick-

personal
colonic
These

the

Center.

dilatation;
inner

evaluation
dilatation

the

Center,

wall;

for the
colonic

sitions

Medical

colonic

colonic

fecal matter.
The adoption

no such

Maimonides

of gaseous
of the

amount

division was made

in this study. Cases
with small
bowel dilatation
were considered
as colonic
ileus, if the colonic
dilatation
was
predominant.
Each
case was reviewed
in detail
for the
following
salient
points:
pattern
and con* From

surgery69

METHODS

constitute
investigation.

for

or

25.

dilated

noted
in Table
ii,
our cases of colonic
ileus
include
a variety
of etiologic
factors.
In
most
instances,
the categorization
of colonic ileus as either
spastic
or adynamic
is
and

raised

poisoning2

Mesenteric

bowel;
haustrations;
appearance
of the

difficult515212225

either

agents6

carcinoma
material

for

with

potassium2

ness

diverticulitis
the
present

ILEUS

22.

14.

emphasis
the

Lead

20.

roentgen
obstruc-

special

disturbances
serum

Fifty cases of colonic

ileus and 70 cases
of mechanical
distal
colonic
obstruction
(i.e.,
distal
to the splenic
flexure)
due to
or

COLONIC

8. Idiopathic6

I I

of

failure22

7. Ganglionic

dilatation.
MATERIALS

appendicitis2

Acute

lowered

colon
and its contents.
The purpose
of this
communication
is to develop
the roentgen
criteria
for the
differential
diagnosis
of
these
entities
based
on the
patterns
of
colonic

Acute

6. Electrolyte

picture
from

of

I.

5. Cardiac

2,1520

and

CAUSES

2.

are

obstruction.
background

comprehensive
analysis
findings
of colonic
ileus

the

obstruction

roentgen

colonic
this

diagnosis

is indistinguishable

of mechanical
It
is against

ZRTED

it
for

Many

that

ileus

criteria

differential
and

to

abdomen,

the

M.D4

reported

Notwithstandin the roent-

experience

diagnosis

Y. SOONG,

YORK

TABLE

due

of the
i.

KENNETH

NEW

of diffuse

dilatation

of causes.
A list
is given in Table

the

gen

is a syndrome

segmental

a variety
etiologies
ing

ileus

ITS DIFFERENTIAL
DIAGNOSIS*

few
made
the

causes
favorable

empirical
in

of

propo-

determining

relative

value

of

York.
Director

of Radiology,

The

Jewish

Hospital

and

David

330

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OF

COLONIC

ILEUS

IN

cholec

SERIES

OF

As
more

6
6
5

Surgery
thrombosis
pancreatitis

Acute

appendicitis

Trauma
abscess

Acute

disease

l1ows,,

ii*idIees

partially

seem
as a
dila-

colon
Li gradually

proximal
to an obstructingr
altered
by the early paria11y
sfructive
man,festations,
so that1
wlw1ii it becomes
dilated
secondary
to more
crpite
obstruction,
its appearance
djffers
/1!Ii
that of a dilated
colon that is otherwise
The

this

margin

of

the

colonic

cwjer

margin

is y

is best
The

hyper-

of the

cannot

be

de-

occasionally

delineat

definition
due
fecal

and.

and

rat-

to mucosl
matter
and

thickening
to muscular

remainder

in the retained
seen
in the

roentgenograms.

muscular

Fluid
or fecal matlumen
and the c&
thickening. The

be

tus

chronic

wall

lineated
with certainty.
er
between
the
bowel
Ionic
wall may
stimulate

becom#{231}s

irregular

apparently
adherent

the

but

before

trophy
may be indicated
roentgenographically
by
and
in certain
areas
appear
numerous
and
closely
packed.
Later,
due to chronic
distention,
the haustrations
become
shallow
or
obliterated
with
a decrease
in the number
of septa.
___________
Muscular
hypertrophy
also
4evaluation
of
thickening
of the colonic wall roentgenographically
is difficult
because
both
the
actual
inner
margin
and the actual
outer

contours

Desp?te
chronic
distention,
a
colonic
septa
remaiii
They
are,
altered
in appearance
with varyof thickening,
irregularity
and

with

suspended
ing can

.
develops,

obstruction
inner
colonic

tiehriition.
The
secondary

trophy

*iPnal.

stimulate

may
be
hyper-

of

the

septal

abnormalities
due to mucosal
edema,
and
adherent
fecal matter
and secretions.
Colonic
obstruction
usually
produces
varying
degrees
of fecal
retention.
However, more important,
the colonic
fecal content
is frequently
altered
from
its normal
semisolid
or solid
consistency.
In many
cases
of chronic
obstruction,
the retained
colonic
fluid has a grey,
finely
mottled
appearance
on roentgenograms.
This
is due
to small
particles
of fecal
matter
finely

PROPOSITIONS

distention

is

It would
propositions
of colonic

intraperitoneal

may

usuai
arp
and become

secretions.
few of the

50

and

1967

ir-

uL#{149}s,,arly,

copnic
tbe

Mhis
e,nd

gastroenteritis

various
roentgen
features.
helpful
to discuss
these
basis for the understanding
tation.

(I)

partial
chronic,

their
srnothness

Total

4esion

OCTOBER,

edema

Pelvic

Soong

io

Acute

Sepsis
Parkinsons

Y.

fidrwdineiita1

CASES

stitis

Mesenteric

Kenneth

fat,
THIS

Idiopathic
Cardiac
failure
Urinary
calculus
Acute

and

II

TABLE
CAUSES

Bryk

evaluated

greater

fluid.
recumbent

in the

the

obstruction,

This

erect

or decubi-

severity

and

the

prominent

more

findstudies

chronicity
will

be the above
findings.
In relatively
acute
colonic
obstruction,
only
a minimal
degree
of abnormality
of the dilated
colon
will be
detectable.
(2)
./jz colonic
ileus,
the appearance
is
that of acute dilatation
of a preiwisly
well
cotour
fea0ures
The

normal
colon. Preserved
haustrations,
defined
septa,
smooth
inner colonic
and thin colonic
wall are the cardinal
of the acuteness
of the process.
amount
of fecal matter
varies
de-

pending

upon

viously
matter,

present
however,

the
in

amount
the
usually

of
colon.
has

normal
consistency
with fecal
left colon
and mottled
semisolid
right colon.
Some
cases of colonic
ileus

feces

pre-

The
fecal
a relatively

boluses
feces

show

in the
in the

a some-

VOL.

ioi,

what
may

No.

more
severe,
be indicated

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tation

with

The

septa

due

to

The

retained

seen

haustral
or

muscular

contents

The

the

less

be

and

picture

severe
extent

more

more

secretions
the
inner

of

roentgen

severe

loss

hypertrophy.

ileus
in the more
thus
merges
to an
in

in the

thickened
may

adherent
feces
slight
irregularity

wall.

This
dila-

septal

slightly

fecal

Ileus

pattern.
colonic
and

appear

edema

colonic
colonic
cases

some

may

fluid
with
producing

less acute
by greater

Colonic

less
with

acute

of

acute
that

cases

of

colonic obstruction.
(3) The relative
amount
oJftuid
andgas
in
the dilated
colon is relaled
to the intraluminal
pressure
wit/s predominant
gaseous
distention indicating
a more
acute
process
wit/i
lower
intraluminal
pressures
and predominantJluiddistention
indicating
a more chronic
process
with higher
intraluminal
pressures.
Therefore,
predominant
fluid
distention
of
the colon
is indicative
of colonic
obstruction.
Roentgen
evaluation
of the
fluid-filled
colon
may
be difficult
unless
attention
is
paid
usually

to

the
ill defined
the cecum
and

fluid
may

may
thus

fluid-filled
ascending

contain
little
be homogeneous

other

uni t-density

tures.

A long

decubi
of gas

tus roentgenogram,
trapped
between

masses,
colon.
The

fecal
and

matter
blend

and
with

intra-abdominal

air

fluid

level

struc-

in

the

erect

or

small
collections
the septa,
or gase-

ous dilatation of the transverse colon may

direct attention
to the
fluid-filled
right
colon.
This
pattern
is not seen
in the colonic
ileus,

in which

dilatation

is acute

and

33
prone

incompetence
times

it

or in the

of
is

the

the

ileocecal

supine

valve.923

predominant

finding.

dilated
colon,
however,
usually
tected
and
shows
the
features
obstruction
outlined
above.
ROENTGENOCRAPHIC

At
The

can
of

be decolonic

FINDINGS

Figure
I illustrates
colonic
ileus
of the
acute
type
(etiology-pelvic
surgery).
The
dilatation
involves
the entire
colon and can
be followed
in continuity
from
the cecum
to the rectum. Figure
illustrates a case of
colonic
ileus with
segmental
dilatation
extending
to the
splenic
flexure
(etiologyrenal
failure).
Figure
3 shows
a similar
case with segmental
dilatation
to the middecending
in the
failure).

colon
but with
more
fecal matter
ascending
colon
(etiology-cardiac
The
colon
in these
3 cases
is sig-

nificantly
dilated
are normal. The
preserved

intra-

roentgenogram

roentgenogram
when it is mobile
and anteriorly
located.
Some
cases of colonic
ileus due to intraabdominal
inflammatory
processes
with
peritonitis
show somewhat
more fluid.9 The
amount
of fluid,
however,
is less than
that
seen
with
colonic
obstruction,
so that
a
completely
fluid-filled
right
colon
is not
observed.
In addition,
the features
of the
gas-filled
colon
are those
of an acutely
dilated
unaltered
colon-the
picture
characteristic of colonic ileus.
Small
bowel dilatation
in colonic
obstruct!rn
is generally
considered
to be due
to

and

but its anatomic

features
haustrations are relatively
regular.

The

septa

are

thin

luminal
pressures
are low. Cecal perforation
due to the high intraluminal
pressures developing in the
dilated
cecum
in colonic
obstruction34
is extremely
rare in colonic
ileus.59
Gaseous
distention
predominates

and well defined.

The inner
colonic
contour
is sharp
and smooth.
The
gas-filled
colon
can be followed in continuity due to the
presence of minimal
fluid.
The
fecal
matter
present
appears
to be of normal
consis-

with

tency.
Figure

relatively

distended

small
colon

can,

amounts

followed
in continuity
from
the distal
dilated
segment.
whelming

majority

of fluid.

therefore,

of

dilatation
extends
into
the
maximum
dilatation
roentgenogram4ljnvolves
colon.
The cecum
may

Cases,

the

The

usually

the
In

be

cecum
to
the overthe

colonic

left colon
and
in the
supine
the
transverse
be severely
dilated

in colonic
spite
the
tions

are

and

sharply

4 demonstrates

ileus
huge

severe

(etiology-hip
dilatation,

present
defined.

and

the

distention

surgery).
Desome
haustrasepta

Gaseous

remain
distention

thin
al-

lows
visualization
of the dilated
colon
in
continuity.
Figure
5 illustrates colonic ileus of the

332

David

Bryk

and

Kenneth

Y.

Soong

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more
chronic
Haustrations

type
(etiology-idiopathic).
are
shallower
and
less

quent

than

in

of

septa

are

the

the

previous

slightly

cases.

44

Colonic

1.

entire

colon

ileus
shows

case

of

colonic

amount
tis wi th
contains

ate
amount
visible.
The

of

of fluid
appearance

but

its

less

gas
the

of
ileus

of fluid
pen tonia modercontent
transverse

is

colon,
however,
is
consistent
with
the
acute
type
of colonic
ileus.
Figure
7 illustrates
a pattern
of chronic
colonic
obstruction
with
marked
abnormality
of the dilated
colon.
There
is marked

(etiology-pelvic
gaseous

shows

and

irregularity

demonstrating
a larger
(etiology-acu
te cholecvsti
tis). The
ascending
colon

gaseous
tions,

FIG.

freMans

thickened

well defined.
There
is slight
the inner
cecal
contour.
Figure

1967

OCTOBER,

surgery).

distention

and

can

The
be

distention,
occasional

but
thick,

with
loss of haustrarather
irregular

defined
septa
and a ragged
the colonic
wall.
Figure
8 illustrates
less

inner

chronic

contour

ill
of

obstruc-

the cecum
to the rectum. The haustrations
are preserved
and regilar
and the septa are thin and sharply
defined (arrows)
followed

in

continuity

from

4
:1
H,

FIG.

FIG. 2. Colonic
tation

the

of

cecum

ileus

the colon
to the

(etiology-renal
is

failure).

segmental,

splenic

small
bowel
dilatation.
The
tively
preserved.
The septa
colonic
contour
is smooth.

flexure.

extending
There

haustrations

are thin

Thedila..
from

slight
are relais

and the inner

3. Colonic
ileus (etiology-cardiac
failure).
The
colonic
dilatation
extends
to the mid descending
colon.
The appearance
of the dilated
colon
is similar to the cases illustrated
in Figures
I and 2. The
semisolid
appearing
fecal
matter
(arrows)
in the
ascending
colon is of normal
consistency
for this
area.

No.

\OL.

101,

tion
tral

with
and

gaseous
distention
septal
obliteration.
9 shows

Figure

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Colonic

retention.
grey
and

a case

Figure

illustrates

10

of

Figure

cecum
matter,

illustrates

ii

colonic

obstruction

colon.

The
I

with
greater

fecal

333

hausfluid

matter

ragged

is
inner

apparently

due

secretions

and

relatively
with

eous distention
and
Some
haustrations
somewhat
accentuated
closely
Figure

the

a dilated

to adherent
fecal
mucosal
edema.

are

with

The
retained
fluid
mottled
in appearance.

contour

verse

but

Ileus

acute

predominant

gas-

absence
of fecal matter.
are
present
and
are
in the distal
trans-

septa

in the

packed.
2 illustrates

a case

hepatic

flexure

with

predom-

fluid
distention.
The
gas is localized
the
transverse
colon.
The
dilated
fluid-

inant

to
filled

cecum

and

ascending

as a mass
density
in
abdomen
with
small
trapped
at the
apices

colon

are

seen

the

right
side
of
collections
of
of the haustrations.

the
gas

5. Colonic
ileus
(etiology-idiopathic).
Colonic
distention
is marked.
Many
of the septa
(large
arrows)
are thickened,
slightly
irregular
and less
well defined.
There
is slight
irregularity
of the
inner cecal contour
(small
arrows).

FIG.

DIFFERENTIAL
(i)

Volvulus.

DIAGNOSIS

In

volvulus,

the

colonic

ob-

struction
is of relatively
acute
onset
and
the dilated
colon
is similar
in appearance
to
that
in colonic
ileus.
A number
of reports34
mention

that

occasional
to

twisting

entities
cases.

sigmoid

volvulus

complication
of

the

dilated

plication
problem.8

as

a complication
obstruction,
and

an

ileus

due

sigmoid.

The

two

are
thus
seen
to merge
Although
cecal
volvulus
has

ported
neoplastic

be

may

of colonic

this

infrequently

in some
been
re-

of mechanical
is a rare
coma

diagnostic

The roentgen
picture in volvulus, therefore,
resembles
the more
severe
cases
of
colonic
ileus in the features
of the dilated
loops.
The diagnosis
of sigmoid
volvulus,
however,
is suggested
by the
prominent
dilatation
of the smooth
walled
ahaustral
11G.

4.

Colonic

ileus

(etiology-hip

is markedly
distended.
latation,
some haustrations
colon

surgery).

l)espite

The

the huge

are preserved

septa
(arrows)
remain
thin
and sharply
Gaseous
distention
allows
visualization
lated
colon
in continuity.

diand the

defined.
of the di-

sigmoid,

into
the
volvulus,
with
its
diagnostic.79

extending

from

the

pelvic

cavity

upper
abdomen.6897
In cecal
the ectopic
location
of the cecum
characteristic
configuration
is

David

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334

Bryk

and

Kenneth

Y.

Soong

1967

OCTOBER,

.p.

8. Colonic
obstruction
due
There
is gaseous
distention,
ofthe
haustrations
and most

to sigmoid
carcinoma.
hut with obliteration
ofthe
septa.

lIG.

6. Colonic
ileus
(etiology-acute
cholecystitis
with peritonitis).
Ihe colonic
distention
extends
to
the splenic
flexure.
The ascending
colon and cecum
contain
a noderate
amount
of fluid producing
a
sott tissue
density
interspersed
with collections
of
gas
(arrows).
The transverse
colon shows
the leattires
of acute
colonic
ileus.

FIG.

Toxic

(2)

ulcerative

dilatation
In

dilated

colon
shows
are seen

ities

than

The
inner

important
contours
projections

deep
(b)

numerous

shortening
an

nodular

of the
obstructing

in

more
severe
abnormalin colonic
obstruction.2

pseudo-polypoid
; and
(c) relative

protrusions

in the proximal
the colon
in this
than
reports

ulcerative
of their

genograms

of
the

findings
are:
(a) irregular
of the colon
with
multiple
indicative
of ulceration;

i ntraluminal
of

during
the course
toxic
dilatation,

colitis.

colon.
A rare complication
neoplasm
is acute
colitis
colon.#{176}2 The
entity
are less
colitis
recognition

as in

toxic

and
on

changes
prominent
there
plain

in

are no
roent-

dilatation.

DISCUSSION

The

previously

discussed

propositions

indicate
that,
in the overwhelming
ity of cases, the findings
on the
genogram

in

abnormality
of

7. Colonic obstruction
due to sigmoid
This is a pattern
of chronic
obstruction

FIG.

carcinoma.

fined

with

tour

severe

colonic

of

the

haustrations,
septa
of

the

(large

colonic

ileus

dilated
occasional

(10 not

colon.

There

thick

majorroent-

plain

resemble

is total

irregular

arrows)

and

a ragged

wall

(small

arrows).

loss

ill
inner

decon-

Voi..

ioi,

No.

colonic
the

obstruction.
colon

In

proximal

altered

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Colonic

in

varing

and
then

contents
by
by mechanical

ileus,
mal

the
prior
which

from

the

obstruction.
From
gram

and

ileus;
criteria
below,

is

its

developing
obstruction.

lesion
and
In colonic

is relatively
episode
and

northen

reflex
differs

mechanism
signiflcantls

mechanical

mechanism

of

the

standpoint

3
obstruction;

()

(2)

previously
86 per cent

of

can

most
likely

likel
colonic

Based

on

most

and

our

be

the

reviewed

cases

into

ileus

cases
(i)

discussed
fall

would

colonic

the

indeterminate.

colonic

roentgeno-

of

categories:

into

an(l

of plain

diagnosis
obstruction,

first

anatomy

obstruction

87 per
Category
colonic

in

colon
acute

differential

(livided
colonic

lesion

dilated
by
probably

colonic

of

colonic

Categor

FIG.

Colonic

10.

due to carcinoma
of the
distended
cecum
(arrows)
inner
contour.
The hepatic
flexure
the transverse
colon are fluid filled.

obstruction

splenic

flexure.

shows
and

a ragged
portions

The
of

gas

1,

cent

of our
cases
of colonic
ileus
in
and
14
per cent
of our cases
of
obstruction
and
13
per cent
of our
2,

of colonic
Category
or more
of the
tinuous
gaseous
cases

In

filled

the

obstruction,

the

degrees

involved
to the

becomes
20,21

colonic

to

335

Ileus

right

colon;

ileus
in Category
are those
cases
following
findings:
colonic
distention;
accentuation

3.
with
two
nonconfluid-

of

haustra-

L
FIG.

II. Colonic

type
There

obstruction
due to sigmoid carcinoma.
Erect
roentgenogram.
The
retained
colonic
fluid
has a grey mottled
appearance
(arrows).

obstruction

to carcinoma

is predominant

of the
of
gaseous

the

relatively
descending

distention

acute
colon.
and

ab-

The haustrations
are somewhat accentuated
in
the transverse
colon
(large
arrows),
but
are
obliterated
in the
ascending
colon.
In the hepatic
flexure,
the septa
are closely
packed
(small
arrows).
sence

FiG. 9. Colonic

due
of

fecal

matter.

336

David

Bryk

and

Kenneth

Y.

tention
regular

OCTOBER,

with
minimal
haustrations;

septa;

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Soong

smooth

normal

fluid;
thin

inner

preserved
well

colonic

consistency

of

able

cause

of the

colonic

examination

not

in

an

these

findings

favor

the
ment

further
of the

diagnostic
patient

this

from

In

be

some

cardiac

is
con-

disease

may

it

or

involve

patient.
the plain

Sig-

The
cliniroentgen-

ileus

and

course
should
be

3 are

those

that

and
treatconsidered

cases

severe

but

with
haustral
and
slight

colonic

ination
further

basis

In

colonic

findings:

distention
fluid;
slight
thickening;
inner

Barium

urgent

standpoint.

Category

following
lic;. 12. Colonic
obstruction
with predominant
fluid
(listention
due
to carcinoma
of the descending
colon.
The gas is localized
to the transverse
colon.
lhe cecum,
ascending
colon
and hepatic
flexure
appear
as a mass
density
in the right side of the
abdomen
(large
arrows)
with small
collections
of
gas trapped
at the apices
of the haustrations
(small
arrows).

Fur-

the clinical
the
prob-

cases.

ditions,
such
as severe
pulmonary
embolism,
nificantjeopardy
to the
cian can be assured
that
ogram

and

contents.

dilatation.

on

necessary

and
defined

contour;

fecal

ther
help
can be obtained
from
history
and
findings
indicating
enema

1967

contemplated

the

colonic

small
amounts
of
loss;
slight
septal
irregularity
of the

contour.

Barium

is necessary
evaluation

with

gaseous

enema

in
these
surgery

and
prior

to

this

exam-

cases
should

for
not

study.

SUMMARY

tions

loss

numerous

with

or

tions;

large
inner
fluid.
barium

closely

considerable
thickened
amounts

these

contour;

and

patients,

sigmoidoscopy

enema

on

ing

septa;
ragged

grey

examination

Iindful

septa;

of haustra-

ill defined,
irregular
of fecal
retention;

colonic

In

packed

shallowness

mottled

and
an

urgent

tematic
gram

the
its

findings

are

fluid;

surgeon

that

are

indicated.

sufficient
the

most

to

indicate

expeditious

to

the

colonic

decompressive
procedure
is necessary.
In
some
cases,
with
large
amounts
of fecal
retention
and
some
gaseous
distention,
barium

enema
study
ting
lesion.
These
are
constipation
and fecal
a neurogenic

or

will show
patients
impaction

psychogenic
In Category
2 are
those
following
findings:
continuous

no obstrucwith
chronic
usually
on

basis.
cases
with
gaseous

the
dis-

the

inadequacy

criteria

analysis
findings
on

of

of colonic
of
co

the
such

the

exist-

ileus,

plain
cases

SyS-

roentgenowas under-

taken,
with
special
emphasis
on the
patterns
of colonic
dilatation
pertaining
to the
acuteness
or chronicity
of the process
and

This
can usually be
performed
without
any
further
jeopardy
to the patient.
If the patients
condition
is
such
as to contraindicate
these
studies,
the
basis

of

roentgen

nature
of
pathogenesis

present
continuous

the

diagnostic
gaseous
preserved

septa;
normal

fecal
contents.
Concurrent
colonic

indicated

criteria
are:

distention;
tuation

study

obstruction

diverticulitis

of

contents.
colonic

features.
dilatation;

regular

well
defined
contour;
and

tain
These

colonic
varies,

ileus

While
did

These

are:
minimal

haustrations;

thin

smooth
inner
consistency
of
due

colonic
of the

70

cases

to

carcinoma

of

low

of

cer-

or

the

validity

which
noncontinuous

favor

obstruction.
gaseous
colonic

fluid-filled

right

haustrations

colon;
with

accennumerous

VOL.

No.

101,

Colonic

closely
packed
of haustrations;

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tention;

septa
large

thickened

septa;
ragged
grey
mottled
Realization
enable

The
not
copy

or

us

ill

to arrive

defined

at

the

of such
enema

extremely
certain

and

MELAMED,

i6.

MORTON,

8o,

may

if not

w.

j.,

JR.

Center

D. J., REYNOLDS,
P. Radiographic
colon
pancreatitis.
Radiology,

2.

BRASCHO,

3.

BYRNE,

J. J.

Surg.,
4.

Large

B. M.,
volvulus

and

39.

906-963.

92,

T. N., and ZANCA,

cut-offsigns
in acute
i 962,
79, 763-768.

bowel

R. Colonic
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Surgery,
1941,
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6. EvIsoN,
G., and
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7. FIGIEL,
L. S., and FIGIEL,
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