barium enema in radiology

 Method

• The ten day rule is followed in female. 
• Single contrast - Uses 

          Children- Because there is no need to see the mucosal pattern, so do single contrast barium enema in children.

          Single contrast method is used to reduce intussusception.

• Double contrast - Mucosal pattern is observed. 
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Indication

1. Change in bowel habit
2. Pain
3. Mass
4. Melaena / anaemia
5. Obstruction

Contraindication

Absolute

• Toxic megacolon
• Pseudomembranous colitis
• Rectal biopsy via:

           a. Barium enema is not done if the endoscopy is done 5 days before the rigid endoscope. 

           b. Barium enema is not done if endoscopy is done 24 hours before a flexible endoscope.  

Relative

• Incomplete bowel preparation. 
• Recent barium meal.

Contrast medium

1. Polibar 115% w / v 500 ml or more. 
2. Air 

Patient preparation

There are lots of regimes of bowel preparation present. Suggested regimes-

• 3 days before examination-

          The patient should be given a low residue diet.

• The day before the exam -

         The patient should be given only fluids.
         Picolax tablet should be given at 08: 00h and 18: 00h.

• Exam day

         Antibiotic prophylaxis should be given to those patients who have a prosthetic heart valve or who have a history of endocarditis.

Preliminary film

Preliminary plain abdominal film is not required unless-

• Patient has severe constipation, which makes bowel preparation doubtful. 
• Toxic megacolon suspected to be 

Technique

1. After heating the patient on one side of it, gently place the catheter in his rectum and connect it to the barium bottle and hand for air injection. 
2. After this barium starts pouring in as well as intermittent screening of barium continues and as barium reaches hepatic flexure and stops barium infusion. 
3. Now slowly pump the air into the bowel so that the barium column moves towards the caecum and produces double contrast effect. Some centers use Co2 gas for a double contrast effect, which reduces the post double contrast enema pan. 
4. Roll the patient on its left side and bring it to the RAO position so that the bowel mocosa will coat well. 

Films

1. Spot film for rectum and sigmoid colon -

• RAO
• Prone
• LPO
• Left lateral of the rectum.

      2. Spot film (Erect) for Hepatic flexure, splenic flexure and rectum -

• LAO to open out the splenic flexure
• RAO to open out the hepatic flexure
• Right lateral of the rectum

      3. Spot film for Caecum (lying) -

• Let the patient sleep on the supine right side in the head down tilt position and take the film. At this stage, the double contrast effect occurs in the caecum. 

      4. Overcouch film- usually exposed to the sealing tube. Large bowel is seen. (lying) -

• Supine 
• Prone
• Left lateral decubitus
• Right lateral decubitus
• Prone with tube angled 45 ° cauded and centered 5 cm above the posterior superior iliac spine.

Aftercare

1. The patient should be told that due to barium, his bowel motions will be white for a few days and there may be problems in flushing. 
2. The patient should be advised to drink sufficient amount of water to prevent barium from freezing. Laxatives can be taken if required. 

Complication

1. Perforation of bowel
2. Transient bacteraemia.
3. Changes in partial large bowel obstruction of patient due to the deposition of barium into complete large bowel obstruction.