barium meal follow through(BMFT)

method

1. Single contrast
2. Double contrast- with gas producing effervescent agent. 
3. Pneumocolon technique 

Indication

1. Pain
2. Diarrhoea
3. Anaemia / gestrointestinal bleeding
4. Partial obstruction
5. Malabsorption
6. Abdominal mass
7. Failed small bowel anaema.

Contraindication 

1. Complete obstruction
2. Suspected perforation

Contrast medium

1. EZ HD 100% w / v 300 ml. It is fed to the patient. Non-ionic water soluble contrast media are given in some circumstances when barium is contraindicated in patients. 

Patient preparation

1. The patient should not be fed anything 6 hours before the exam. (Nil orally for 6 hr prior to the examination).
2. Patients are advised not to smoke during the procedure as it increases gastric motility. 
3. Metoclopramide 20mg orally is given 20 minutes before the procedure. 

Preliminary film-

• Plain abdominal (KUB) film

Technique- 

1. A column of barium is to be made in the small bowel. For this, the patient is fed barium and put to sleep on his right side. Metoclopramide increases the rate of stomach emptying of the patient. 

Films- 

1. Abdomen's prone PA film is taken every 20min in the first hour. Thereafter every 30min until the barium reaches the colon (large intestine). To separate the loops of the small bowel, the patient is moved prone, causing the loop to separate due to pressure on the abdomen. 
2. The spot film of Terminal ileum is taken supine. To separate another loop from the terminal ileum, a compression pad is placed on the abdomen. 

Additional films-

1. To separate loops of small bowel-

• Oblique
• KUB with x-ray tube angled into the pelvis
• KUB with patient tilted head down.

      2. To demonstrate diverticula-

• Erect- Fluid levels can be detected from this position. 
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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. Barium leakage from unsuspected leakage | 
2. Changes in partial large bowel obstruction of patient due to the deposition of barium into complete large bowel obstruction. 
3. Barium appendicitis due to the accumulation of barium in the appendix.