Prospective, randomized comparison of castor oil and sodium phosphate preparation for barium enema.

OBJECTIVE: To compare castor oil and sodium phosphate preparation (Swiff) in patients' satisfaction, efficacy for colon cleanness, side effects, and prices. MATERIAL AND METHOD: One hundred patients referred for barium enema were randomized to receive castor oil (n = 50) and sodium phosphate preparation (n = 50). They graded their satisfaction using a 5-point scale (easy, acceptable, slightly difficult, extremely difficult, and unacceptable). The efficacy for colon cleanness was graded by two radiologists using a 5-point scale (excellent, easy for evaluation, acceptable, difficult for evaluation, and unacceptable). Side effects were evaluated by patients' vital signs, total number of bowel frequency, and 10 associated symptoms. RESULTS: Both preparations revealed no difference in patients' satisfaction (p = 0.882) and efficacy of colon cleanness (p = 0.130). Sodium phosphate preparation was more expensive (79 vs. 10 Baht) and caused higher number of bowel frequency (p < 0.001). CONCLUSION: With a cheaper price, castor oil was comparable with sodium phosphate preparation in patients' satisfaction and efficacy of colon cleanness.

Computed tomographic findings in differentiating between diverticulitis and colon cancer.

Objective: To determine the computed tomographic (CT) findings associated with diverticulitis or colonic cancer, and to evaluate the CT signs that may help in distinguishing between these two diseases. Methods: Fifty-five CT scans of patients with colonic diverticulitis (n=17) or colonic cancer (n=38) between January 2002 to October 2005 were retrospectively and independently evaluated by two abdominal radiologists who were blinded to the proved diagnosis. Discrepancies of each CT finding were resolved by consensus opinion. CT findings were assessed as follows: location of involved colon, length of involved segment, degree of pericolonic inflammation, pericolonic lymph nodes, thickness and pattern of bowel wall thickening, presence or absence of simple diverticula at the involved colonic segment, inflamed diverticula, intramural sinus tract, fistula, muscular wall hypertrophy, “arrowhead” sign, extraluminal air and bowel obstruction. The inter-observer agreement was assessed with the kappa statistic. The association of consensus opinion of each CT findings with the final diagnosis of colonic diverticulitis or colon cancer were evaluated by using chi-square test and odds ratios. Results: Bowel wall thickness less than 1 cm ( p < 0.0001, odds ratio 32.89, 95% CI 3.31,798.5), presence of simple diverticula at involved segment ( p < 0.001, odds ratio 28.13, 95% CI 4.56, 266.11), presence of inflamed diverticula ( p = 0.003, odds ratio 15.42, 95% CI 1.46, 386.32) and symmetrical pattern of bowel wall thickening( p < 0.0001, odds ratio 13.07, 95% CI 2.66, 73.36) were the statistically significant CT findings which are found more frequently in colonic diverticulitis than in colon cancer. On the other hand, bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the statistically significant CT findings seen more frequently in colon cancer than in diverticulitis. Conclusion: Bowel wall thickness less than 1 cm, presence of simple diverticula at the involved segment, presence of inflamed diverticula and symmetrical pattern of bowel wall thickening were the helpful CT findings in distinguishing colonic diverticulitis from colon cancer. Bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the useful CT findings in distinguishing colon cancer from colonic diverticulitis.