Digestive disorders

II./3.1.: X-ray

To image diverticulosis, which is in fact a colon pseudodiverticulum, colon must be filled by contrast material from the direction of the rectum. In addition, double contrast colonography can be also used, and asymptomatic diverticulosis can be revealed incidentally on barium enema studies performed for another reason.

Initially only small spiculum, in later phase mushroom shaped flares can be observed which have a smooth contour and exceed the colon contour and are principally located on the sigma and descendent colon by decreasing incidency towards orally.

Diverticula imaged in tangent to the X-ray beam (orthoroentgenograd direction) can be differentiated from the small polyps by their very sharp outside contour and blurred inner contour of the ring. In contrast, inner contour of the polyp neck sorrounded by contrast material looks sharp whileas the outside contour is blurred. If diverticulum is filled by stool, obviously no contrast filling will be observed.

Diverticulum contrast filling can be also observed if no rectal contrast agent was given, since the oral contrast material can slack in the diverticula for several days. Therefore, we must be informed by the fact and result of the recently performed gastroenterological examinations in order to avoid the false diagnosis of entero- or faecolith. Known diverticulosis and the fact that the prevalence and increment of colon diverticula increases in line with the advanced age (at least one third of patients over 50 years of age has diverticulosis) suggest the suspicion of diverticulitis.

Furthermore, clinical symptoms, such as intermittent, often left lower abdominal pain, fever and inflammatory lab parameters also suggest this diagnosis. At least every tenth patient with diverticulosis is affected during their lives by this disorder. Important to note that in case of diverticulitis, especially in its acute phase barium suspension enema and air blow studies are prohibited! Because of the danger of perforation and the fact that barium can stick in diverticula, this study can be only performed by water soluble, absorbent (iodic solution) contast material!