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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/08 01:59:55」(JST)

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Enteroclysis according to Sellink in a patient with Crohn's disease showing a stenosis of the ileum

MR enteroclysis in Crohn disease: substantial wall thickening and contrast uptake in the affected bowel segment

Enteroclysis is a fluoroscopic X-ray of the small intestine. Radiocontrast is infused through a tube inserted through the nose to the duodenum, and images are taken in real time as the contrast moves through aided by administration of methyl cellulose. Enteroclysis is also known by the confusing misnomer small bowel enema. 'Enema' is confusing as it suggests that the contrast material is introduced through the anal route.

It was the gold standard for evaluating small bowel diseases like Crohn's, though it has largely been replaced by CT enterography. CT enteroclysis is now available which combines the advantages of CT (ample extraluminal information and visualization) and conventional enteroclysis (distension of small bowel for visualization). A report suggested CT enteroclysis to be superior to conventional enteroclysis in evaluation of symptomatic Crohn's disease, especially for the detection of fistula, abscess, skip lesions, lymphadenopathy, and conglomeration of small bowel loops.^[1]

MR and CT versions exist.^[2]

Indications

Apart from Crohn's disease as mentioned above, enteroclysis is invaluable in small intestinal obstruction. In this condition it helps to distinguish the complete (which requires early operation) from the incomplete varieties of obstruction (or occlusion).
Any suspicion of a large bowel (ie, colonic) obstruction precludes an enteroclysis until the possibility has been excluded. If enteroclysis is conducted in a patient suspected of large bowel obstruction, the ileocecal valve will pump the contrast material into the dilated caecum which lies proximal to the obstruction in large intestine. This can cause a perforation.

References

^ Sailer, J.; Peloschek, P.; Schober, E.; Schima, W.; Reinisch, W.; Vogelsang, H.; Wunderbaldinger, P.; Turetschek, K. (Dec 2005). "Diagnostic value of CT enteroclysis compared with conventional enteroclysis in patients with Crohn's disease.". AJR Am J Roentgenol 185 (6): 1575–81. doi:10.2214/AJR.04.1534. PMID 16304016.
^ L. Santiago Medina (30 April 2011). Evidence-Based Imaging: Quality Imaging in Patient CareRevised Edition. Springer. pp. 578–. ISBN 978-1-4419-7776-2. Retrieved 27 June 2011.

UpToDate Contents

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1. 小腸腫瘍の診断および病期分類 diagnosis and staging of small bowel neoplasms
2. 原因不明の消化管出血の評価 evaluation of obscure gastrointestinal bleeding
3. 成人におけるクローン病の臨床症状、診断、および予後 clinical manifestations diagnosis and prognosis of crohn disease in adults
4. 成人における機械的小腸閉塞の疫学、臨床的特徴、および診断 epidemiology clinical features and diagnosis of mechanical small bowel obstruction in adults
5. 成人における腹痛に対する診断的アプローチ diagnostic approach to abdominal pain in adults

English Journal

Clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation.

Li D1, Li R, Wu P, Li X, Zhang X.
Cell biochemistry and biophysics.Cell Biochem Biophys.2014 Sep;70(1):349-53. doi: 10.1007/s12013-014-9919-2.
To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray re
PMID 24715234

Update on imaging of Peutz-Jeghers syndrome.

Tomas C, Soyer P, Dohan A, Dray X, Boudiaf M, Hoeffel C.
World journal of gastroenterology : WJG.World J Gastroenterol.2014 Aug 21;20(31):10864-10875.
Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the STK 11 gene and is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract in association with a hyperpigmentation on the lips and oral mucosa. Patients affected by PJ
PMID 25152588

Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography.

Braithwaite KA1, Alazraki AL.
Pediatric radiology.Pediatr Radiol.2014 Aug;44(8):926-31. doi: 10.1007/s00247-014-2907-2. Epub 2014 Feb 18.
Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The "star sign" is a radiological finding of internal fistula that has previously been described in the gastroenterology literatur
PMID 24535118

Japanese Journal

胃と直腸に髄外性病変を認めた多発性骨髄腫の1例

望月洋介,齋藤康晴,稲富理,小泉祐介,馬場重樹,仲原民夫,辻川知之,石田光明,安藤朗,藤山佳秀
日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 53(3), 1090-1096, 2011-03-20
症例は70歳代前半男性．腰痛を伴う高蛋白血症，高Ca血症，腎機能障害にて当院紹介受診．多発性骨髄腫と診断され化学療法にて寛解となるも，半年後に腹痛，腹満感が出現．腹部CTにて肝右葉に腫瘤を，また上部下部消化管内視鏡にて直腸および胃病変を認め，各々生検にて骨髄腫髄外病変と診断した．その後化学療法の反応乏しく，約5カ月後に死亡した．多発性骨髄腫の消化管髄外性病変は稀であり，本例では胃と直腸に認めたため …
NAID 10028053286