Radiographic Findings Related to Abnormal Motor Activity

Abnormal Peristalsis. Segmental acceleration is seen in some sprue patients followed by a period of diminished peristalsis; conversely, when barium has reached segments where normal peristalsis is impaired and almost absent it will remain in these segments for 30 to 45 minutes. If there is associated loss of tone, the caliber is markedly increased. This is a common finding in sprue. Injection of carbachol does not have an effect on these affected segments. This latter finding also is reliable and can be correlated with the clinical severity of the disease.

Intermittent transient intussusceptions can occur in sprue as the active segment pushes into an inactive one (Fig. 16.4). The "to and fro" movement of the small bowel may separate the barium column normally at times into smaller columns; this should not be mistaken for the "segmentation" pattern.

Fig. 16.4 Tropical sprue with multiple jejunal intussusceptions. Multiple recurrent or intermittent intussusceptions can occur in the small bowel as a result of segmental hyperactivity alternating with hypoactivity. These intussusceptions are transient and reduce spontaneously. (A) An erect film from a small bowel series in a patient with tropical sprue shows a normal mucosal pattern in the proximal jejunum and slightly rapid transit time. (B) Multiple areas of intussusception are seen in the mid and lower jejunum on a later film of the same study. (C) A 2 hour follow-up film shows that the intussusceptions have resolved spontaneously. Segmentation of the barium column as well as dilution and coarse clumping of barium are noted throughout the distal jejunum and proximal ileum.