This atlas is a selection of roentgenograms of patients who visited the radiology departments at the University Hospital in Leiden between 1970 and 1978, the Free University Hospital in Amsterdam in 1979, and the radiology department at the Indiana University Medical School in Indianapolis in 1977. The most common radiological abnormalities of the small intestine are illustrated clearly, unhindered by flocculation or segmentation of the contrast fluid. The authors believe this book is a definite contribution to the goal of precise early small bowel diagnosis. However, the key to good diagnosis is not only a superb examination technique, but also the knowledge, the character, and the personal perfectionism of the physician. If these factors are optimal, then the best possible roentgenographic series will be obtained - at least as far as the technique is concerned. All patients illustrated here were examined by using the enteroclysis technique. With this method of small bowel examination, the contrast fluid is administered via an infusion directly into the duodenum instead of orally. The infusion method has added a new dimension to the usual radiological examination of the small intestine. This method is also especially suited for the comparative evaluation of motility, and the study of disturbed motility. Throughout the course of the examination, the technique can be adapted to special situations at any given moment and can be modified to produce precise diagnostic roentgenograms and diagnosis.

VI J. R. VON RONNEN PREFACE This atlas is a selection of the roentgenograms of patients who visited the Radiology Department at the University Hospital in Leiden between 1970 and 1974. The heads of this department are Prof. J. R. von Ronnen and Prof. A. E. van Voorthuisen. In this atlas, the most frequently occurring radiological abnormalities of the small intestine are illustrated as clearly as possible - without the shadows caused by flocculation or segmentation of the contrast fluid. The author hopes it will be a positive contribution towards the attainment of the highest possible diagnostic score. It should be remembered that the key to good diagnostics is not only a perfect examination technique, but also the knowledge and character of the physician. If these factors are optimal, then the best possible series of roentgenograms will be obtained, at least as far as technique is concerned. All patients were examined by the enteroclysis technique. With this method of examination of the small intestine, the contrast fluid is administered via an infusion directly into the duodenum instead of orally. The infusion method has added a new dimension to the radiological examination of the small intestine. This method has turned out to be especially suitable for the comparative evaluation of motility, and also for the study of disturbed motility.

Our knowledge of the diseases of the small intestine has increased greatly since the second world war. The advances made in the auxiliary sciences, in particular biochemistry and histology, are mainly responsible and have led to their increased importance in this field. It is unfortunate that although radiology also contributed new understanding, it has not been able to match the progress of the other sciences. In spite of the advancements made in, for instance, vascular examination, radiology has experienced a relative decrease in its importance to the differential diagnosis of the diseases of the small intestine. The main reason for this is that radiology can only offer an extremely modest contribution to the differentiation between the many diseases with the malabsorption syndrome. In a number of cases, radiological differential diagnosis is in principle not possible because there are only histological and biochemical abnormalities of the mucous membrane of the small intestine without macroscopic abnormalities. There remain however many diseases with malabsorption for which a morphological examination can be highly valuable. This applies for: 1. diseases with gross anatomical abnormalities: anastomoses, fistulae, blind loops; strictures, adhesions; diverticula. 2. diseases with local, usually rather gross mucosal abnormalities: leukemia, Hodgkin's disease, lymphosarcoma; intra-mural bleeding; local edema due to venous congestion (e. g. thrombosis) or lymphatic obstruction (irradiation treatment). 3. diseases with more general mucosal abnormalities: edema due to: lymphangiectasis, allergic reactions, protein-losing enteropathy; amyloidosis, Whipple's disease, scleroderma.