Retrograde ileography

The distal ileum, the segment most frequently affected by small intestinal disease, may be difficult to visualize by conventional X-ray techniques. In recent years, various methods have been described for retrograde ileography during or after colonoscopy. However, these methods require special equipment and may be difficult to perform in practice. Therefore, a somewhat modified technique has been tried out. Patients with suspected distal ileal disease are examined on a fluoroscopy table at the X-ray department. When necessary, biopsies are taken during the introduction of the scope. With the tip of the colonoscope in the terminal ileum (or coecum) a catheter is introduced through the biopsy channel into the distal ileum. Water-soluble contrast (Mixobar) is then instilled under fluoroscopic control and films are taken in the supine, oblique and prone positions. Owing to gas already present in the ileum, a double contrast effect is obtained. The ilography is completed in 5-10 minutes and entails no additional discomfort for the patient. The technique is easy to learn and requires no special equipment. It does not obviate the need for conventional small bowel enema, but may be a valuable supplement to this examination when distal ileal pathology is suspected. 5 refs., 3 figs