This is a double contrast

BE (barium enema). For

this test we put a small
amount of contrast in the
colon to coat the surface
and then distend the
colon with air.
Can you identify the
sigmoid colon?

What are these small

saculations in the
sigmoid colon?

These are sigmoid

diverticula.
What is the main reason we
perform a double contrast BE?

To look for colon cancer.

This an oblique view. The

patient is lying on his left
side. Do you seen all of the
contrast on the dependent
side of the colon?

What do we have to do to
make sure that there is no
polyps or cancers hiding in the
dense contrast?

Flip the patient on to his right

side. See next slide.
 Can you find the splenic
and hepatic flexures on
this image?

Hepatic flexure

Splenic flexure

You could see how a lesion

would be difficult to see in
one of these flexures due to
overlap of the colon. How
could we clear this up?

If we did more films with

some obliquity we could
eliminate this overlap.
This is a single contrast
BE (no air only contrast).
Can you see the narrowing
in the transverse colon?
(Large circle)
Do you know what this is?

This is an
adenocarcinoma. This is
what is classically
described as an apple
core lesion.

Do you see the

resemblance?
This is the
preliminary
image from an
abdominal CT.
Can you see
the contrast
filling the
colon?
The image on the
right shows the
level at which the
axial CT slice was
taken.
What is this high
attenuation
structure in the
liver?

This is the left

portal vein. Do
the portal veins
divide the liver
into segments?

No, the hepatic

veins do.
What is this black
line that runs
through the liver?

This is the fissure

for the
ligamentum
teres. What
structure ran
through this
region?

The umbilical
vein

What is this
fissure anterior
to the caudate
lobe?
This is the fissure
for the
ligamentum
venosum
What part of the
colon is this?

This is the distal

transverse
extending to the
splenic flexure.

Why does the

colon look
white?

The patient was

give oral
contrast.
What portion of
the pancreas is
this?

This is the tail

What portion of
the colon is this?

Hepatic flexure
What is this
venous structure
extending from
the left kidney to
the IVC?

This is the left

renal vein
What portion of
the colon is
labeled by this
arrows?

Ascending
colon

Descending
colon
What is this
vessel coming
of the aorta?

Hint, it is
colonic supply
and below the
level of the
SMA.

Inferior
mesenteric
artery
Look at the small
bowel without
contrast (white
arrows) and the
colon (black
arrows) with
contrast and
note that the
bowel wall is
extremely thin.
Normally
approximately 3
mm.
What is this small
tubular structure
partially filled
with contrast on
this and the
subsequent
image. (see next
slide for answer)
This is the
appendix. Note
this is normal;
thin walled,
filled with
contrast and no
inflammatory
changes in the
adjacent fat.
What portion of
the colon is
labeled with
arrows?

Sigmoid colon
What vascular
structures are
marked by the
arrows?

The external
iliac arteries
and veins
What is this fluid
filled structure?

The bladder

What portion of
bowel is this
located
posterior to the
bladder and
anterior to the
sacrum?
The rectum

What is the
significance of
the space
between the
bladder and
the sacrum?

This is the most dependent portion of the peritoneal cavity in a male.

This is the first
of sequential,
coronal images
illustrating
branches of the
SMA.

This is aorta
(black arrows)
and proximal
SMA (white
arrows)
Which branch off
the SMA is marked
with the black
arrow? Hint, it
comes off
anteriorly

Middle colic
artery

Which branch
is this?

ileocolic
Which branch is
this? (kind of
subtle in this
patient)
Right colic
artery
Which vessel is
this coming off
the aorta?

IMA
This is a 3D
image showing
the branches of
the SMA.
This is another 3D
image showing
the vasculature of
the SMA. Click
through the next
20 frames to
rotate the image.
Awaiting SMA angiogram for Dr.
Aruny
This is a clip from a virtual
colonoscopy. This is
reconstructed data from a CT
scan. The holes at the
bottom of the image are
diverticula.
This is another
image from
reconstructed data
from a CT scan. Do
you see the cancer.
Hint, remember the
apple core.
This is a patient
with diverticulitis.
Trace the sigmoid
colon (white
arrows) over the
next 6 images and
noted the wall
thickening and the
mesenteric fat
stranding (circle).