The Anatomy of the Normal Small Intestine as Observed Roentgenographically

IN 1921 R. Walter Mills reported the results of a roentgenographic study of “small intestinal states” and in his report called attention to the fact that very little effort had been expended in investigating the normal and abnormal conditions of the small intestine by means of the X-ray. He discussed at length a new hypothesis of the transmission of tension in the gastrointestinal tract. He did not, however, discuss the detailed anatomy of the small intestine, or offer any plan of procedure by which the small intestine could be studied in detail during the routine roentgenographic examination of the gastro-intestinai tract. We believed that a procedure of roentgenographic examination could be devised which would show the anatomical details of the small intestine as clearly as we have shown those of the stomach, cap and colon. This would enable us— (1) To recognize the roentgenographic appearance of the normal small intestine, together with those variations in appearance which come within so-called normal limits; (2) To study the motor phenomena of the small intestine; (3) To recognize and identify pathological conditions involving the small intestine and functional derangements of the small intestine. This report will describe a method of roentgenographic examination by which it is possible to make visible the small intestine, and will describe the roentgenographic appearance of the small intestine and those normal variations in appearance which are most often encountered. Methods of Examination The following conditions must be fulfilled in order to secure roentgenographic visibilization of the small intestine: 1. An opaque medium must be used of such composition and consistency that it will pass out of the stomach at a fairly rapid and uniform rate of speed. 2. The medium must be of sufficient consistency to pass evenly — and preferably fairly slowly — through the intestine. 3. Roentgenographic examinations must be made at intervals which will show the various parts of the small intestine when they are best filled. The opaque medium which has proved most successful in use is a moderately thick paste of barium sulphate and water. Thoroughly mix eight ounces by weight of barium sulphate with five ounces of water. This makes a mixture of seven ounces volume: more than this amount is not necessary. Avoid over-distention of the stomach, as this not only gives a less satisfactory visibilization of the stomach and cap, but also causes the stomach to obscure an unnecessary amount of the upper intestine. This study is based on the routine roentgen examination of the gastro-intestinal tract of patients at the office. The examination for the small intestine has varied to a certain extent as the experimental work has progressed. The following is the most satisfactory routine procedure.