Topographic Diagnosis

Whether a lesion is located on the mesenteric side or the opposite side is an important clue in the differential diagnosis of intestinal diseases; previously it could be determined only after surgical findings were available and surgical specimens obtained. Using double-balloon endoscopy, it is now possible without having to resort to surgery. When the double-balloon endoscope is used, the small intestine often forms concentric circles because of its insertion characteristics. In this case, the small intestine forms circles around the fan supported by the mesentery (Fig. 10.1.5). Under these conditions, the side facing the center of the concentric circles is the mesenteric side. When the endoscope tip is moved toward the center of the circles under fluoroscopic guidance, the wall coming into the endoscopic view is the one on the mesenteric side. In Crohn's disease, ulcers are often found longitudinally on the mesenteric side, and Meckel's diverticulum is characteristically found on the side opposite to the mesentery.

0 0

Post a comment