[Opaque enema as the first test: is it always the right choice?]. / Clisma opaco come primo esame: è sempre una scelta giusta?

Dual contrast barium enema is the first investigation which is performed in a patient with symptoms of colic pathology. According to the results the doctor will decide whether to continue with further tests. The authors have carried out a retrospective study of the consequences of this diagnostic iter in an attempt to establish whether barium enema can be used as grounds to identify patients requiring further tests, also taking into account the costs of this diagnostic procedure. The medical records were examined for all patients admitted to hospital with colic symptoms and subjected to barium enema and then total colonoscopy in our unit from January 1990 to April 1992. A total of 131 patients were included in the study, of which 71 were males and 60 females, with a mean age of 62.4 years (range 22-89). Patients with rectorrhagia (59) routinely underwent barium enema and, irrespective of radiological results, colonoscopy. Patients with other forms of colic symptoms (72), with the exception of rectorrhagia, only underwent colonoscopy if barium enema was positive. Radiological findings were divided into positive, negative and radiological images of uncertain interpretation, were controlled using colonoscopy. Colonoscopy was total in 115 cases (87.5%), partial due to the presence of insuperable stenoses in 10 cases (7.4%), and incomplete due to technical difficulties in 6 cases (5.1%). In 24 cases endoscopy showed false negative (18.3%), false positives in 20 cases (15.2%) and uncertain radiological findings in 15 cases (11.4%) with no pathological endoscopic finding. In one case (0.7%), barium enema failed to make the entire colon opaque.(ABSTRACT TRUNCATED AT 250 WORDS)

[Congenital dilatation of the extrahepatic biliary tract]. / La dilatazione congenita della via biliare extraepatica.

Congenital dilatations of the extrahepatic bile duct are examined with special regard for the operating techniques proposed for their correction. After pointing out that the terminology adopted in the literature does not reflect the real morphology of the malformation, and lends itself to erroneous interpretations, a modification is proposed. The basis for the paper was provided by a case of complex malformation of the extrahepatic bile duct (dilatation of the whole duct, with a dividing wall along nearly its whole length) observed in a girl of 15. The case was successfully treated with choledocho-cysto-jejunostomy.