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Barium Enema

A barium enema is an x-ray exam used to view the large intestine. It involves inserting a catheter into the rectum and slowly infusing barium sulfate suspension and air to coat the bowel walls and distend the intestine for imaging. Multiple images are taken in different positions as the barium travels through the colon to fully visualize it. Potential complications include perforation, obstruction, or water intoxication.

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Hamzeh Almasri
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3K views19 pages

Barium Enema

A barium enema is an x-ray exam used to view the large intestine. It involves inserting a catheter into the rectum and slowly infusing barium sulfate suspension and air to coat the bowel walls and distend the intestine for imaging. Multiple images are taken in different positions as the barium travels through the colon to fully visualize it. Potential complications include perforation, obstruction, or water intoxication.

Uploaded by

Hamzeh Almasri
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Barium Enema

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine.

Methods
Double contrast:
The method of choice to demonstrate mucosal pattern.

Single contrast uses:


Children since it usually is not necessary to demonstrate mucosal pattern. Reduction of an intussusception.

Indications
Change in bowel habit Abdominal pain Abdominal Mass Melaena (dark feces)

Contraindications
Toxic megacolon Pseudomembranous colitis Rectal biopsy within 7 days Imminent abdominal bowel surgery

Barium Enema Procedure


Contrast medium
500 ml of 125% v/w barium sulphate suspension. Air

Patient Preparation
Low residue diet for 3 days before the examination, On the day before the examination fluids only The patient evacuates his bowels immediately before the examination

Preliminary Film
Plain abdominal radiograph to check abdominal preparation and exclude toxic megacolon

Technique
 The patient lies on their left side (Sim s position) and the rectum is catheterized, the catheter taped in position and connected to the barium / air introduction equipment.  An intravenous smooth muscle relaxant (Buscopan / Glucagon ) is administered (in the mid of procedure)

 The patient lies supine,  The barium is infused slowly as far as the splenic flexure under fluoroscopic control.  Air is then introduced to force the barium towards the caecum and producing the double contrast effect by coating the bowel wall and distending the bowel with air.  The patient position is adjusted under fluoroscopic control as the complete colon is visualized as the barium travels round to the caecum.

Typical Film Series


 Spot films of rectum and sigmoid region (lying):
 RAO  Prone  LPO  Left Lateral of the rectum

 Spot films of the hepatic flexure, splenic flexure and rectum (erect):
 LAO to open out the splenic flexure  RAO to open out the hepatic flexure  right lateral of the rectum

 Spot films of the caecum (lying).positioning of the patient supine, lying slightly on the right side and with head slightly tilted down.  Overcouch films to demonstrate all of the large bowel(lying)
 supine  prone  Right and left lateral decubitus  Prone, with the tube angled 45 degree caudad and centered 5 cm above the PSIS. This view separates overlying loops of sigmoid colon.

 Post evacuation supine film (is not taken routinely)

Complications
 Perforation  Obstruction particularly if there is a constriction already present due to a neoplasm.  Venous extravastion causing a pulmonary embolus,  Water intoxication due to water absorption from large surface area of dilated bowel  Cardiac arrhythmia s due to rectal distension

prone

lateral

Right lateral decubitus

Left lateral decubitus

Post evac

rectosigmoid

Left decubitus

A.ileum B.cecum C.ileocecaljunction D.semilunarfold E.descendingcolon F.ascendingcolon G.transversecolon H.Sigmoid colon

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