On the basis of 27 personal cases of adenocarcinoma of the intestine and a review of the literature, the authors discuss present-day knowledge about this pathology from both radiologic and therapeutic viewpoints. This study, which excludes papillary tumors, reveals that, on a para-clinical level, barium follow-through examinations allow correct diagnosis in 85% of cases. Arteriography does not provide any special data, and more recent techniques such as ultrasound and C.T. do not appear suited for use in initial investigations. From a therapeutic standpoint, surgery is the only effective solution, but long-term survival had not increased for forty years. This rare form of cancer, with an especially insidious clinical course, has thus not benefited from recently introduced diagnostic and therapeutic technics.

In addition to personal observations of 77 patients with one or more metastatic sites in the gastrointestinal tract, the authors reviewed over 1000 similar cases in the literature. The general radiologic aspects of each location (oesophagus, stomach, intestine, colon/rectum) are discussed. The pathophysiology of this type of metastasis explains the radiologic images obtained during barium transit examinations. The lymphatic type of spread observed in the oesophageal region in connection with carcinoma of the breast is the origin of stenosis of the middle third. The haematogenous type of diffusion encountered during melanomas creates intramural or intraluminal radiologic images. Two means of spread can be observed in the stomach. Haematogenous spread can result in frequently multiple and ulcerated nodular submucosal lesions from melanomas and bronchogenic carcinomas; it can also cause a more or less stenotic invasive image, especially in connection with carcinoma of the breast. Dissemination by means of the mesenteric reflections, and in particular around the gastrocolic ligament, explains the spread of a carcinoma of the transverse colon towards the stomach. The most frequent secondary sites in the gastrointestinal tract occur in the small intestine, the majority of these metastases being caused by pelvic tumours. Whether occurring in the small intestine or the colon, the pathophysiology is similar: direct invasion by a non-contiguous primary carcinoma along the fascias and mesenteric attachments (more rarely by lymphatic permeation), dissemination by the peritoneal fluid or haematogenuous spread. In the first two types of dissemination cited, the image encountered is often hard to differentiate from radiation-induced lesions.

On the basis of 144 radiation-induced intestinal and colorectal lesions seen in 109 patients, the authors review the radiologic aspects associated with such affections. Two points are emphasized: (1) the chronic and still active nature of radiation-induced injury which can explain the appearance of lesions more than 10 years after irradiation, and (2) the locoregional nature of the affection which warrants systematic exploration of the urinary tract by intravenous pyelography in addition to radiologic and endoscopic investigation of the digestive tract. The authors also advise an echography and/or CT scan to detect any neoplastic recurrence.

A critical evaluation of non-biological complementary examinations of the biliary tract was conducted to assess their value when deciding on therapy. The published literature was reviewed, and the sensitivity and specificity of the different methods presented, emphasis being placed on the primary investigations of ultrasonography and oral and intravenous biligraphy. Secondary exploratory procedures (transparietal cholangiography, retrograde endoscopy with cholangiography and pancreatography, scintigraphy, gallbladder infusion parietography, scanography, and arteriography) are defined and their value discussed. Published data suggest that ultrasonography should be the initial investigation, this often being sufficient to enable suitable therapy to be chosen. Only approximately 5 p. cent of patients are unable to benefit from gallbladder exploration, and these require conventional radiological examinations before deciding on therapy.