X-Ray Diagnosis of Ileus. Comparison of Results Obtained by Roentgenograms in Horizontal and Upright Positions

The value of plain roentgenograms of the abdomen without the administration of contrast substances in the diagnosis of ileus has been repeatedly emphasized by clinicians. Goehl, Lynch, Borman, and Wangensteen 1 found experimentally that roentgenologic evidence was of less value in the presence of strangulation than in simple obstruction. The roentgen diagnosis of ileus is based upon the fact that in obstruction there is an accumulation of gas and fluid proximal to the point of obstruction which can be visualized roentgenological. Whereas the presence of gas visualized in the roentgen plate is of diagnostic value, it is considered by many observers 2 that the finding of multiple fluid levels (demonstrated by obtaining the roentgenogram in such a way that the junction between gas above and fluid below may be visualized) is of greater diagnostic importance.

The present investigation was undertaken to compare the results obtained with roentgenograms taken in the horizontal position and those taken in the upright position, the latter technic demonstrating fluid level formation.

Ninety-four observations were made on 19 dogs. At each observation, 2 roentgenograms of the abdomen were obtained, one with the animal in the horizontal position, and the other in the upright position. The x-rays were made by means of a specially constructed radiographic animal board. 3

A simple obstruction of the jejunum and terminal ileum was produced in 3 and 7 animals, respectively. A “strangulated” obstruction of the jejunum, ileum and sigmoid flexure of the colon was produced in 2, 5, and 2 animals, respectively. Roentgenograms were taken at intervals after the obstruction, varying from 1 to 75 hours.