Fig. no.10 (b)
 Fig. no.10 (c)

Contrast enema examination of large gut of a baby shows the intussusception producing a concave defect in the head of the contrast column. Sometimes contrast medium may pass beyond this, causing the well known coiled spring appearance.

(iii) Large bowel obstruction:
Usual causes are the
a) Carcinoma -60% is situated in the sigmoid colon
b) Diverticular disease c)Volvulus of the colon.

Key to the radiological appearance of the large bowel obstruction
depends on the state of the competence of the Ileocaecal valve. The obstructed colon invariably contains large amounts of air and can usually be identified by its location and by the presence of haustral markings.

Fig. no.11. Shows hugely dilated large gut. Its a case of sigmoid volvulus. A haustral loop of sigmoid is seen rising out the pelvis in the shape of an inverted 'U' Dilated haustral colons are present on the two sides of the volvulus.

When both small and large bowel dilatation are present in a case of large bowel obstruction, the radiographic appearance may be identical to those of a paralytic ileus.

Paralytic ileus causes when intestinal
peristalsis ceases and as a result fluid and gas accumulates in the dilated bowel. It is frequently found in cases of peritonitis and in the post operative cases. Along with the radiological findings, history and clinical signs are helpful in differentiating between large bowel obstruction & paralytic ileus

 
Fig. no.11-

Fig.no.12--Th/s film shows generalised  dilatatlon of both small and large bowel and its a case of paralytic ileus.


Acute pacreatitis: Clinical diagnosis may be difficult in the initial stage .Other acute abdominal conditions such as perforation, acute cholecystitis, acute peptic ulcer have to be included in the differential diagnosis. A large number of radiological signs have been described, most of them are non-specific.USG and CT are the diagnostic modality.


Fig. no. 13- -Shows the transverse scan of normal pancreas and its duct.

The normal pancreas has about the same echogenecity as that of liver but its echogenecity increase with age. When we scan the pancreas we usually identify the following anatomical landmarks:

1.Aorta
2. Superior mesenteric artery
3. Superior mesenteric vein
4. Liver etc.

Average diameter of the head of the pancreas is 2.8 cm. body 2 cm and tail 2.5cm, duct diameter less than
2mm.

In acute pancreatitis pancreas is diffusely enlarged and oedematous which is hypoechogenic in comparison with the liver parenchyma. Diffusely enlarged irregularly hypoechogenic pancreas may also seen in acute pancreatitis when it is superimposed on chronic pancreatitis. C. T. is the
investigation of choice for such cases.


Fig. no. 14- -Shows diffusely enlarged and oedematous Pancreas

Rest of this article will be published in next issue of "The ORION".