The Early Radiological Diagnosis of Diseases of the Pancreas and Ampulla of Vater: Elective Exploration of the Ampulla of Vater and the Head of the Pancreas by Hypotonic Duodenography

John Doppman, MD
JAMA. 1966;196(3):303. doi:10.1001/jama.1966.03100160153062.
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The essence of this monograph is contained in its subtitle, "Elective Exploration of the Ampulla of Vater and Head of the Pancreas by Hypotonic Duodenography." To most American radiologists, this procedure will be an unfamiliar one. The strikingly detailed duodenal studies illustrating this book should do much to popularize the technique.

The basic idea of hypotonic duodenography is temporarily to abolish duodenal peristalsis and tone and then to distend the duodenum with barium injected under pressure. Ileus is achieved by the intramuscular injection of an anticholinergic drug after an intestinal tube has been positioned in the duodenum. A viscous local anesthetic is injected, followed by thick barium paste which completely distends the flaccid duodenum, molding it against the pancreatic head. Double contrast studies complete the examination.

Although more complicated than routine barium studies, this procedure seems safe, and duodenal visualization is remarkably improved. Following a section on normal anatomy and


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