BARIUM ENEMA

INTRODUCTION

It is the radiographic study of the large bowel by administration of the contrast medium through the rectum.

ANATOMY

•The large intestine, also known as large bowel is the last part of GIT tract that is 1.5m in length.

•It absorbs the water and remaining waste material is stored as faeces.

•It consist of ceacum, ascending colon, descending colon,transverse colon,sigmoid and rectum.

•It begins in right iliac region of the pelvis and continues up to the abdomen (ascending colon) then across the width(transverse colon)  and then it turns down descending colon(descending colon) continuing to its end at the sigmoid and rectum.

PREPARATION

•patient should be given low residue diet for 2 days prior to the examination.

•patient should be ask drink plenty of clear fluid on the day preceeding the examination.

•Medication that contains Iron should be stopped 2 days before the examination. Patient should remain empty stomach for investigation

LAXATIVES

CASTOR OIL (30ML) :

•Irritant cathartic.

•cheap, though unpleasant to take but gentle in effect.

BISCODYL (15-20MG)

•Irritant cathartic

•contact laxative belonging to polyphenolic group of compound.

•eg :dulcolax

MAGNESIUM CITRATE

  • saline type cathartic is more pleasant to take than magnesium sulphate.
  • magnesium and the sulphate are poorly absorbed from the gut, leading to osmotic retention of fluid and increased peristalsis.
  • headache is the more common side effect.
  • Eg;citramag

BOWEL WASH

  • night before the procedure
  • In the morning, 2 hours prior to the procedure
  • pass the tube beyond rectosigmoid junction and 1.5-2 litres of fluid is infused.
  • patient lies :
    • left lateral receiving first 500 ml
    • prone position receiving second 500ml
    • right lateral position receiving 500 ml.

DOUBLE CONTRAST BARIUM ENEMA

INDICATION

  • For high risk patient -rectal bleeding, history of colorectal cancer.
  • demonstration of sinuses and fistula.
  • patient with diverticulosis(bulging pouches) or diarrhoea.
  • presence of obstruction.

CONTRAINDICATION

  • Allergy to barium sulphate.
  • peritonitis i.e. inflammation of peritoneum
  • acute or inflammatory colon disease.
  • History of recent rectal biopsy

PROCEDURE

  • High density(75-95%) w/v barium suspension is given.
  • patient in prone position with left side down oblique.
  • BA suspension is allowed to flow upto splenic flexure.
  • Air is introduced with patient prone.
  • Air should push barium column and never pass beyond the column.
  • Frontal view of rectum taken in prone.
  • patient turned left lateral for lateral view.
  • oblique right side down for rectosigmoid junction is taken.
  • Patient will be in prone position with right side down position.
  • Air is pumped into the left sided colon.
  • When barium reaches the transverse colon, Patient turned left side up.
  • Barium enters right sided colon & reaches the IC junction
  • take film for IC junction.
  • With right side up more air is pumped till air outlines IC junction.
  • Spot film is taken for flexure & IC junction.
  • Full films in supine, erect is taken.

SINGLE CONTRAST BARIUM ENEMA

INDICATIONS :

  • evaluation of acute obstruction or volvulus
  • reduction of intussusception.
  • show configuration of colon

CONTRAINDICATION

  • allergy to barium suspension
  • risk of perforation
  • peritonitis
  • Suspicion of acute / fulminating ulcerative colitis

PROCEDURE

  • low density 15 -20% w/v barium suspension is given
  • patient in left side down lateral
  • Patient is turned prone, frontal view film of rectum is exposed
  • Patient kept prone with right side down oblique (helps in opening up the curve of rectosigmoid junction)
  • Spot view of rectosigmoid junction with barium flowing is taken
  • Patient kept prone oblique with left side down
  • Spot view of splenic flexure is taken
  • Patient turn right side down, spot film of hepatic flexure is taken.
  • As soon as reflux occurs at IC junction, films are taken.
  • A full film is taken to show the entire colon
  • Pelvic outlet view for rectum give 30 degree cranial angulation to the tube with the patient supine,pelvic symphysis and sacral promontary overlap
  • Pelvic inlet view for sigmoid : Taken before the barium covers the transverse colon. 30 degree caudal tilt is given to the xray tube with patient supine.

ADVANTAGES OF DOUBLE CONTRAST OVER SINGLE CONTRAST

Better surface details.

Surface lesions can be demonstrated

Easy unraveling of the colon as it is possible to look through loops.

DISADVANTAGE OF DOUBLE CONTRAST OVER SINGLE CONTRAST

Difficult in cooperative patients.

fistulae/sinuses can be missed.

effacement of submucosal detail of the colon.

WATER SOLUBLE BARIUM ENEMA

•GASTROGRAFFIN •(1:3 DILLUTION WITH WATER)

COMPLICATION

can result from :

  • preparation of patient.
  • pharmacological agents( buscopan, anaphylactic reaction)
  • procedure
  • perforation
  • inspissation of barium (causing severe constipation)

AFTERCARE OF THE PATIENT

•The patient should be warned that his bowel motion will be white for a few days after the examination. •laxatives should be used to avoid barium impaction in patients with constipation.

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One comment

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