[Lymphographic visualization of the rectal lymphatic channels and nodes]

Injection of Lipiodol U.F. was effected in the submucosa of the rectum. Injection was done exactly 1,6 mm into the wall. This created a wheal from which reflux of the contrast medium occured. Up to 5 ml Lipiodol U.F. were injected in this manner. Roentgenograms were made in two planes after 2,4,8,24 and 48 hours; occasionally, oblique or spotfilm exposures were taken. Accumulation of the contrast medium began after only 2 to 4 hours, usually reaching its maximum after 12 hours. Thereafter, no further lymph nodes became apparent, so that radiographs taken at this time are representative of final stage. This procedure was carried out on 12 patients suffering from rectum carcinoma and on one patient with a villous adenoma. All tumors were located at a depth of 4 to 6 cm. The results are demonstrated by pictures. The lymph was found to flow longetudinally in the wall of the rectum. The order of appearence of the nodes was arbitrary. Due to the small size of the lymph nodes, no preoperative conclusion could be drawn as to wether or not they had become metastatically infested. The postoperative radiographs provided a check in the radicality of the operative procedure, especially in those cases in which lymph nodes had been clearly visible. Because of the viscosity of the contrast medium and because of the quantity that remained in the submucosa and was resorbed by the lymph channels, the method was self-limiting.