Signs and Findings

The macroscopic forms of rectal cancer are in agreement with the endoscopic findings: - polypoid or vegetating forms tend to grow into

Fig. 2. Double-contrast barium enema. AP view. Flat vegetating lesion with wide, irregular and retracted base: adenocarcinoma of the lower rectum (arrow)

Fig. 3. Double-contrast barium enema. AP view. Rectal tumour with circumferential growth in the sigmoid colon (arrow), with severe stenosis of the colonic lumen

Fig. 2. Double-contrast barium enema. AP view. Flat vegetating lesion with wide, irregular and retracted base: adenocarcinoma of the lower rectum (arrow)

and to obstruct the intestinal lumen showing an irregular ulcerated surface, irregular, rigid and retracted base from mural infiltration;

- infiltrating forms starting as plaque lesions growing on the visceral walls. If the growth is circumferential the tumour is annular or has the appearance of the core of an apple (Fig. 2);

- stenosing forms with more or less marked reduction of the intestinal lumen (Fig. 3). Frequently several macroscopic aspects are combined together.

The strong points of barium enema are represented by: (1) concomitant visualisation of the viscus in its entire length (pan vision); (2) stenotic portions are not an obstacle; (3) the function is studied; (4) radiographs enable an objective documentation of the lesions. The weak points are: (1) the need for a high standard procedure; (2) the need for perfect intestinal cleansing; and (3) the need for complying patients.

An extremely rare reaction from barium hypersensitivity has been reported [13]. The most severe complication is definitely perforation, which in most cases involves the rectum and is related to the air inflation, especially when performed with balloon catheters in a diseased rectum. Colonic enema should never be performed after perendoscopic biopsy in a diseased or normal colon, as this is the major predisposing factor for mural perforation [14].

Minor complications may be considered as the pain from gas distension or following the exam.

Colonoscopy and double contrast colonic enema have an overall accuracy of about 90%.

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