Uzunov, G.

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Varna Medical University Press: Journals

D I F F E R E N T I A T I V E ROENTGEN DIAGNOSIS OF MALABSORPTIVE SYNDROME G. Uzunov The term "malabsorptive syndrome" (MS) defines a group of heteroge-neous diseases wi th a common sign — a defective absorption of the main com-ponents of food (carbohydrates, proteins, fats) in the small intestines. C l i n i -ca l ly it is manifested by abundant, fatty, stenching faeces, loss of weight, ab-dominal intumescence, skin pigmentation, slow development, various insuf-ficiencies such as folic acid, v i tamin B 1 2 , iron, B-complex vi tamins, v i t amin K> calcium and magnesium. Greater part of the diseases which are c l in ica l ly manifested wi th MS have characteristic Roentgen ( X - r a y ) symptoms that allows a precise differentia-tive diagnosis ( D D ) by investigating the passage of the intestines wi th barium sulphate. The object of the present study was to establish the diagnostical value of the X - r a y examination of the digestive tract of 52 patients wi th MS accepted to our department in the period 1970—1980. Materials and methods Our study covers 19 patients of the group "spru", including the chi ldish coeliac disease and non-tropical spru in adults, investigated by barium sul-phate. The in i t i a l diagnosis was suggested only after the first X - r a y exami-nation. The intestinal biopsy, confirming the diagnosis, was performed to 9 of the patients; however, the final diagnosis was discussed after the effect of the glutenless diet (regimen). 6 of the studied objects were aged between 7 months and 1 year, 10 were between 1 and 14 years and the rest 3 — between 15 and 28 years. The second group in our study was that one of children wi th lambliosis — 11 altogether, aged between 3 and 7 years. The diagnosis was discussed after the X - r a y examination and then confirmed by the results of the investigation of bilecontent received through a duodenal catheter. The rest 22 patients of our study were from various groups; 4 of them wi th gastrectomia, 4 — pancreatic insufficiency, 3 — regional enteritis, 2 — ga-stroilleosthomia, 2 — liver and bile disorders, 2 — illeocoeacal T B C , 2 — sclerodermia, 1 — lymphosarcoma, 1 — innate duodenal stenosis, 1 — me-senteral vessel insufficiency due to thrombangiitis. Results and discussion The patients wi th coeliac disease had in various degree a l l aforemention-ed intestinal disorders — dilatat ion, segmentation, fragmentation, flocula-tion and hypersecretion. Temporary non-obstructive invaginations i n two of the patients were registered but a passage prolongation was not reported. The Differentiative roentgen diagnosis of. 63 most constant symptom observed in every (patient wi th a coeliac disease and non-tropical spru was the intestinal dilatation. I t was excellently demonstra-ted in the graphs (the contrast substance was swallowed 1 hour before) of the Fig . 2 Fig. 1 middle and distal part of jejunum (fig. 1). A 28-year old woman in a heavy c l in ica l status and 22-kg weight-loss plus cachexia had only one single X - r a y symptom: inte-stinal di latat ion. The glutenless regimen improved totally her condition (fig. 2) . The dilatation of intestines is never so constant wi th any disease than spru. Considerable dilatation was registered wi th 2 patients suffering from sclerodermia, but the sk in disorders in both cases preceded the intes-t ina l ones. ' , Segmentation was established wi th most of the patients in later graphs, at the end of the second hour (fig. 3) . The distal ileum was usually affected. A rough, unproper, irregular, snow-like floculation was detected after the evacuation of intes-tinal knots in the patients wi th an expressed segmentation. The hypersecretion was manifested in various degree and hydroairy sha-dow-like spots were observed in 4 children. The mucous relief was smoother in 18 patients and in 12 of them a so called "moulage symptom" was estab-lished. Temporary intususceptions of small into small intestine without inte's-Fig. 3 64 ч G. Uzunov t inal block were found in 2 patients (fig. 4) . The duration of the passage was between 3 and 5 hours. The only patient wi th MS and lymphosarcoma of intestines shew X - r a y picture very similar to coeliac disease, but the mucous relief was quite rough (not smooth) and knotty destructions untypical for the coeliac disease. The dilatation was not so well expressed (fig. 5) . S imi la r differentiative-diagnos-t ical difficulties were reported by other authors too (Sleisenger et a l . , 1953). The children wi th MS and lambliasis had pathological changes located main ly in duodenum and proximal parts of jejunum where the mucous wr in-gles were thicker and unproperly ordered. Spasmic waves and quicker trans­port of the contrast substance through the inflammated intestinal parts were registered. Hypersecretion and floculation was detected in only two children. Patients wi th lambliasis combined wi th MS reported also some other investi­gators (Hoskins et a l . , 1967; Yard ley and Bayless , 1967). No intestinal dis­orders besides quicker passage in the gastroesophageal tract of patients wi th MS were registered after surgical treatment. Four patients with a pancreatic insufficiency and two wi th choledochial obstruction and biliac-pleural fistules caused MS were treated surgically and no pathological changes in their intestines were registered after that. The patients wi th a regional enteritis shew stenosis of the terminal i leum and one of them even had together wi th it an affected ileocoecal part of the colon. T h e pathological changes of the two patients wi th ileocoecal T B C were Fig. 4 Fig. 5 Differentiative roentgen diagnosis of. 65 very s imilar for those wi th regional enteritis, byt the present nodular defects and TBC-changes in other organs allowed their differentiation. A n innate stenosis of the distal part of duodenum and proximal dilatat ion was found in a chi ld , aged 16 months, wi th M S . The reason for that is a pos­sible bacterial supereffect on the structure ( K i n et a l . , 1966). The patient wi th mesenterial vessel insufficiency due to the visceral ob­literating thrombangiitis shew a normal passage. The arteriography detected obliteration of the mesenterial arteries and A . gastroduodenalis. The passage of the studied 52 patients was undoutfully important for the diagnostical investigation of 37 of them ( 7 1 % ) . The other 14 patients requir­ed passage-examination too, although it was not so important ( 2 7 % ) . The only patient ( 2%) wi th mesenterial vessel insufficiency shew that the X - r a y investigation was not so important for the final diagnosis because it was not the passage-examination which proved the proper diagnosis but was the arte­riography. R E F E R E N C E S 1. H o s к i n s , L . C. e t al. Clinical giardiasis and intestinal malabsorption. Gastroenterology, 1967, 53, 265—279. — 2. K i m , V . S. е t a 1. The role of altered bile acid metabolism in steatorrhea of experimental blind loop. J. Clin. Invest., 1966, 45, 956— 962. 3. L a w s , J . W. e t al. Correlation of radiological and histological findings in idiopathis steatorrhea. Brit. Med. J., 1963, 1, 1311—1314. — 4. M a r s h a k, R . H . , A . E . L i n d n e r . Radiology of the small intestines. W. B . Saunders Company, P h i ­ladelphia, 1970, 9—29. — 5. S l e i s e n g e r , M . D . , Т. P . A l m y, D . P . В a r r . The sprue syndrome secondary to lymphoma of the small bowel. Am. J. Med., 1953, 15, 6 6 6 — 6 7 4 . - 6. Y a r d l e y , J . H . , T . N . B a y l e s s . Giardiasis. Gastroenterology, 1967, 52, 301—304. Д И Ф Ф Е Р Е Н Ц И А Л Ь Н Ы Й Р Е Н Т Г Е Н О В С К И Й Д И А Г Н О З М А Л А Б С О Р Ц И О Н Н О Г О С И Н Д Р О М А Г. Узунов Р Е З Ю М Е Проводится анализ дифференциального рентгеновского диагноза малабсорбцион-ного синдрома у 52 больных И различними заболеваниями. Наибольшее число с о с т а в ­ляет группа больных целиакией и нетропическим спру. Второе место занимает группу больных ламблиазом. К остальным заболеваниям относится регионарный энтерит, и л е о -цекальный туберкулез, склеродермия, лимфосаркома, недостаточность поджелудочной жлезы, хирургические операции желудочно-кишечного тракта, заболевания печени и желчных протоков, врожденный стеноз двенадцатиперстной кишки и сосудистая и н с у -фициенция брыжейки. Исследование проходимости тонких кишок оказывается р е ш а ю ­щим у 71 больных. У остальных больных это исследование является необходимым, но не и решающим для диагноза исследованием. 5 Seripta scientifica medica 

DIFFERENTIATIVE ROENTGEN DIAGNOSIS OF MALABSORPTIVE SYNDROME

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DIFFERENTIATIVE ROENTGEN DIAGNOSIS OF MALABSORPTIVE SYNDROME

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