To the Editor.—Our report on the efficacy of barium in the diagnosis of bleeding Meckel diverticulum (Arch Surg 108:361, 1974) was based on retrospective examination of records and radiographs of patients of many physicians. One can always find inadequacies when no prearranged protocol has been utilized. The critical comments made cannot be entirely refuted; we are merely reporting our experience in an active children's hospital.
At barium enema, the distal part of the ileum is filled with barium as often as possible (probably 60% to 70% of the time) if there is no contraindication. Only four of 32 patients had small bowel examinations, frequently because early surgical intervention precluded a complete examination once gastrointestinal tract disease was excluded. But it does not seem unreasonable to expect a low yield on these exams performed here in the general run of children in whom—statistically 1% to 2% should have a