Barium Enema

BARIUM ENEMA

Definition

• Indication
• Contraindications
• Equipment used
• Contrast media used
• Describe technique of barium enema
• Adverse effects
• After care of the patient

What to look for(normal barium anema)

Definition

Barium enema is a special radiological procedure of the large intestines following retrograde injection of sulfate contrast (barium sulphate) through anus done under fluoroscopy.

Its for evaluation of anatomy, physiology and pathology of cecum, colon(ascending,transverse colon, descending colon ,sigmoid colon),rectum and anus.

Indications

• Unexplained change in bowel habits
• investigation of non-specific abdominal pain
• Abdominal mass
• Melena (dark feces due to blood)
• Suspected ulcerative colitis

Suspected Diverticulum

Suspected Polyps

Suspected Intussusception

• Suspected volvulus
• Suspected Neoplasm( colorectal cancer)

Suspected Strictures

• Hirschsprung's disease

failed colonoscopy

notes

If a tight stricture is demonstrated, run a small volume of barium proximally to define the upper margin for other wise barium may impact

Hirschsprung's disease (HD

Barium Enema

is a form of megacolon that occurs when part or all of the large intestine or antecedent parts of the gastrointestinal tract have no ganglion cells and therefore cannot function.

During normal prenatal development, cells from the neural crest migrate into the large intestine (colon) to form the networks of nerves called the myenteric plexus (Auerbach plexus) (between the smooth muscle layers of the gastrointestinal tract wall) and the submucosal plexus (Meissner plexus) (within the submucosa of the gastrointestinal tract wall).

In Hirschsprung's disease, the migration is not complete and part of the colon lacks these nerve bodies that regulate the activity of the colon.

Contraindications

• Absolute:
• Toxic mega colon
• Pseudomembranous colitis
• Suspected bowel perforation
• Rectal or colonic biopsy within the past 5 days
• Relative:
• Partial obstruction
• recent barium meal (wait 7 – 10 days)

Pt. frailty

General contraindication

• Acute appendicitis
• Perforation
• Pregnancy
• Severe diarrhea
• Incomplete bowel preparation

Rectal biopsy within the last 5 days.

Equipment used

Fluoroscopy Unit

Other accessories

• cassettes,
• Anatomical markers rt or lt.
• Foot rest
• Hand grips shoulder support

Lead aprons, gloves thyroid shield

Patient Preparation

• As per barium meal…
• Plain abdominal film look for
• Obstruction
• Megacolon
• Calcification

Bowel preparation

Contrast medium used and supplies

• 1000 – 1500ml of 115% w/v barium sulphate suspension

500ml for double contrast plus air

SUPLIES

Enema container (1lt on its stand and tubing system with y or T shaped the way glass connector and suitable) Rector catheter

• Higginson's syringe
• Bed pan
• Lubricant KY gel
• Plenty of towel
• Sticking plaster
• Gloves
• Clamp
• Jug of water
• Kidney dish
• Enema tray

Makingtosh

Trolley set up

please make follow up at the department..

Preparation of the patient

• As per barium meal..

In some cases enema wash out is advised

Methods of performing Ba. enema

• Single contrast enema:
• Refer t exceptional in barium meal
• Double contrast enema:

Method of choice to demonstrate mucosal pattern.

Procedure/technique

DOUBLE CONTRAST

protocol

Pour 500mls of the suspension into an enema bag, run barium from the enema bag into the plastic tubing to expel the air and finally clamp the tubing.

Place the patient on his left, lubricate the enema tip(the rectal catheter),and insert gently into the patient rectum.

Protocol…..

Connections are made to the barium receiver and the hand pump for injection of air.

Unclamp the tubing and allow barium to flow by gravity or by gently squeezing the enema bag The infusion of barium released via rectum and the progress is screening, Then Patient lies prone

as the barium reaches to the hepatic flexures ,the infusion is terminated.

Protocol…..

When the bag is empty of barium or reaches to the hepatic flexures,…..

Now the air is gently pumped into the bowel, forcing the column of barium round towards the caecum and producing double contrast effect The insufflating of air is at the rate of not more than one puff per second.

Protocol…..

From prone position the patient is rolled into the left side and over into an RAO position so that the barium coats the bowel mucosa.

Then spots films are taken;…

Films taken/position(INDIVIDUAL)

FILM / POSITION

PURPOSE/ REGION DEMONSTRATED

• Left lateral, prone, RAO,LPO
• Rectum and sigmoid colon
• LAO
• open out the splenic flexures
• RAO
• open out the heaptic flexures

RIGHT LATERAL

• the rectum
• RAO, RPO (table horizontal)

Caecal pole

GENERAL SPOTS FILMS

• left lateral/RT lateral—–RECTUM
• sigmoid, descending colon, splenic flexures— LAO
• transverse colon/hepatic flexures—–RAO
• ascending colon and cecum——-SUPINE

whole large bowel———-PRONE

Rotate the patient back into LPO position take images of hepatic flexure

Rotate the pt into RPO position. Take spot image of splenic flexure

Pliz continue to read table tilting with their degrees as well as parts demonstrated……

NOTES

post evacuation film is not taken routinely but if taken may allow improvement assessment of the cecum, when other film has failed OR to asses amount of barium expelled

After care, Adverse effects, Complications as per previous study

What to look for

NORMAL BARIUM ENEMA

Can you see pre sacral space(retrorectal space)

Normal 1-2 cm

Some of the condition associate with retro rectal space < or >

• Chondroma
• Proctitis
• Prostatic enlargement
• Lipomatosis
• Ca rectum
• Obesity
• Tumor of the sacrum
• Thrombosis of the IVC

Granulomatous colitis

Can we sing radiology song?

ok lets sing together

Quiz 3

• What are preparation of the patient prior to the barium enema examination
• What are 5 advantages of taking preliminary film prior to the barium study examination
• What is Chrohn’s Disease?

What is toxic megacolon?