From Big Medical Encyclopedia

DUODENOGRAFIYA RELAXATION (Latin duodenum a duodenum + Greek grapho to write, represent; lat. relaxatio relaxation, reduction of tension) — X-ray inspection of a duodenum in the conditions of its artificial hypotonia. The technique was offered for the first time by the Argentina surgeon Liotta (D. Liotta, 1953) then its various modifications appeared.

Of river apply to diagnosis of diseases of a duodenum, including its big nipple, and a head of a pancreas, napr, for the purpose of identification of the reason of jaundice and narrowings of a gleam of a gut.

For obtaining hypotonic effect use the cholinolytic means reducing motor activity of a gut: 3 — 5 ml of 0,1% of solution of Methacinum subcutaneously or intramusculary; 1 — 2 ml of 1% of solution of aprophene subcutaneously or intramusculary; 1 ml of 0,1% of solution of atropine from 10 ml of 10% of solution of a gluconate of calcium intravenously; 0,75 ml of 0,2% of solution of aceclidine subcutaneously or intramusculary. Atropine and aprophene should not be applied at disturbances of coronary circulation; besides, atropine is contraindicated at glaucoma and hypersensitivity to drug.

Of river make in two modifications — with the probe and without probe. Of river with the probe carry out at horizontal position of the patient in the following sequence: the probe under control of roentgenoscopy is entered into a duodenum to the level of its lower horizontal branch; then make an injection of cholinolytic and 10 — 15 min. later by means of a Janet's syringe enter a liquid baric suspension (100 — 150 ml) via the probe. Along with it carry out rentgenol, a research: a X-ray analysis in various projections (under control of raying) in a phase of partial and hard filling with the subsequent inflation in a gut of air for receiving a pneumorelief.

Of river without probe carry out in the course of a usual rentgenol, researches went. - kish. a path (if there is a need). To the patient enter cholinolytic, give inside an additional portion of a contrast agent and carry out a series of pictures by the technique described above.

Roentgenogram of a duodenum (relaxation duodenografiya). The black arrow specified the probe for introduction to a duodenum of a contrast agent: 1 — is normal; 2 — at an ulcer of a diverticulum (it is specified by a white arrow).

Rentgenol, a picture of a normal duodenum in a condition of its relaxation (fig., 1): diameter of a gut is evenly expanded to 5 — 6 cm, contours its accurate, evenly gear, the size of teeth almost identical. Distances between teeth correspond to width of normal circular folds. Walls of a gut keep elasticity; therefore, despite muscular relaxation, slow advance of contrast weight on a gut is observed that allows to receive a pneumorelief, without resorting to preliminary suction of contrast weight via the probe. At a X-ray analysis in the left slanting projection it is possible to receive the image of a big nipple in the form of flat defect of filling on an internal contour of a duodenum approximately on the middle of its descending part. Thanks to expansion of a gleam of a gut and a prileganiye of its gipotonichny walls to adjacent bodies of D. of river allows not only to reveal patol, processes in the gut, napr, diverticulums, ulcers of a diverticulum (fig., 2), but also to judge, by indirect signs, about a condition of a head of a pancreas, the general bilious channel, retroperitoneal limf, nodes. So, in case of increase in a head of a pancreas (cancer of its head, hron, pancreatitis) at D. of river, except expansion of its loop, signs of a compression of a duodenum can be found: change of the perpendicular direction of folds at an internal wall on slanting, up to total disappearance of stepped appearance and straightening of a contour of a gut. Emergence of a symptom of impression of an internal wall, emergence of a double contour of a gut at a prelum of a front or back wall is possible.

At defeat of the wall of a duodenum (cancer of a big nipple, germination of cancer of a head of a pancreas in a duodenum, etc.) method D. of river zones of rigidity of a wall, infiltration, regional or central defects of filling with uneven contours with considerable deformation or disappearance of folds of a mucous membrane in these sites, and also changes of a big nipple come to light.

Complications at D. of river practically do not happen. In rare instances patients note dryness in a mouth and short-term heartbeat; disturbance of accommodation is sometimes observed. The specified symptoms in 20 — 30 min. after the research disappear.

See also Duodenum, radiodiagnosis .

Bibliography: Varnovitsky G. I. and Vinogradov V. V. X-ray inspection of a duodenum in the conditions of its artificially created hypotonia, Vestn, rentgenol, and radio-gramophones., No. 5, page 33, 1960; 3ubarchuk S. K. and Ishchuk A. G. New option of a tubeless duodenografiya in the conditions of artificial hypotonia, the Doctor, business, No. 12, page 15, 1972; To the Slave cinchona N. And. and Salman M.M. Recognition of diseases of a duodenum and the bodies surrounding it by means of a duodenografiya, M., 1966, bibliogr.; Rybakova N. I. and With and l m and M. M. K N to a technique of a research of a duodenum in the conditions of its hypotonia, Vestn, rentgenol, and radio-gramophones., N ° 4, page 42, 1961; L io t t a D. Pour le diagnostic des tumeurs du pancreas, la duodenographie hypotoni-que, Lyon, chir., t. 50, p. 455, 1955.

H. I. Rybakova.