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Barium enema is a radiographic imaging procedure done to examine the colon (large intestine) for diagnostic purposes. It is also most commonly known as the lower gastrointestinal tract series examination. There are two types of barium enema which are single contrast technique and the double contrast technique. The single contrast technique only involves barium sulfate injected into rectum to obtain a profile view of large intestine whereas the double contrast technique involves air and barium sulfate being injected into the rectum simultaneously to create a three dimensional look of the structure. It uses barium sulfate as contrast media and X-rays to enable the soft tissue of large intestine to be visualized and differentiated from the bony tissue. The contrast media of barium sulfate is given rectally which is administered into the anus. This examination normally takes place in hospital but some clinics offer this procedure as well. Barium enema is less common now since the advent of colonoscope which is endoscopy of colon. However, it is still practiced in the hospital as there are certain areas that colonoscope is unable to reach. Besides that, barium enema relatively costs lesser compared to colonoscope. Despite the given benefits of barium enema, a biopsy on the large intestine can be done by performing colonoscope. Through barium enema examination, we are able to ascertain a number of pathologies involving the large intestine. The preparation of patients for barium enema examination must be thorough, starting two days before the examination. Preparations must also be done to prevent any complications or risks posed while the examination takes place. Though it's relatively safe for this procedure to be carried out, certain risks and complications may also occur to certain patients.
Barium enema is done to determine the cause of pathologies involving the large intestine (colon). One of the reasons is to help in the diagnostic of colon and rectal cancer. Diverticula which is pouches pushing out of colon, structural changes in large intestine as well as polyps which is the benign growth in the tissue lining the colon and rectum can be detected by performing barium enema. Double contrast barium enema is usually done for detection of small polyps, bleeding cause by ulcers and early inflammatory disease. There are also other indications that lead to the examination being done mostly depending on the patients altered bowel habits' history. They can be due to consistent constipation, severe diarrhea, patients experiencing mucus, blood or pus in stool and lower abdominal pain. A detailed barium enema can also reveal large intestine narrowing.
Patients have to be well prepared prior to the examinations in order to capture the best image possible for diagnostic purposes as well as to prevent any discomfort to the patients. Bowel preparation is done two days before the examinations take place. Patients must be brief in detail on the preparation to facilitate for the examinations. Most often, the examinations are scheduled to be in the morning as it requires patients to fast at least six hours before examinations. Patients are highly recommended to practice a low fibre diet. High fibre food such as meat and milk products should be avoided for the preparation. Patients may consume plain white bread, porridge ad fish for the first day of bowel preparation while clear fluids such as glucose, water, and clear chicken soup can be taken for the second day of bowel preparation. Patients must also be advised to take in loads of fluids (water) to compensate the body fluid loss when the medicine for bowel cleaning takes effect. Patients will also be prescribed with laxatives such as Dulcolax to help bowel movement one day prior the examinations. Lastly, patients must not take in any food or fluid six hours before the barium enema procedures take place. Before the procedure starts, a simple examination interview may also be conducted to find out patients' history on the procedure, reactions towards contrast media, surgeries done involving the lower gastrointestinal tract, allergies towards drugs as well as curret drug therapy. For female patients, they will be asked of their last menstrual period to ensure that they are not pregnant.
Once confirming patients are well prepared for the examinations, they will be asked to change into hospital gown. All potential artifacts such as nipple, belly button ring, necklace, bracelets, dentures belts and etc. must be removed. Patients will be then briefed on the whole process of the procedure as well as have risks and complications explained to by radiographers. A consent form is signed by the patients as an approval for the examinations. A preliminary film will be taken before the administration of contrast media to assess whether the colon is cleansed of stool during the preparation process. Preliminary film is also done to determine the exposure factors needed for the barium enema examinations. The preliminary film is usually done when patients are in antero-posterior (AP) supine position and image shall include the lower abdomen. After getting approval from radiologist to proceed with the examinations, patients will be assisted for the administration of barium through enema (rectally). A well lubricated catheter will be inserted into the patients' anus to allow the radiologists to slowly administer barium into intestine. The patients must also keep the anus tightly contracted against the catheter so that the barium does not leak from anus during the contrast media filling process. Keeping anus tightly contracted is important as diagnostic inaccuracy may occur should the barium leaks. A rectal balloon will sometimes be used to help retain the barium in the patients' anus. As barium fills the large intestine, images of lower abdomen is taken to distinguish any findings. There are ways to perform a barium enema. In one of the way, the rectal tube is removed shortly after filling and the patients expel as much barium as possible. In another way, the tube remains intact and barium moves through the tube. A coating of barium is left on the inside surface of colon (mucosa area). Air is then slowly injected into the intestine the rectum to expand the bowel lumen and patients are screened under direct fluoroscopy. This is necessary as abnormality of colon is difficult to detect in a collapsed or contracted state. Patients will also be asked to move and position themselves on the bucky table in order to take images of different parts of colon. Patients are expected to keep the barium and air in the large intestine until the end of examinations.
Upon completion of barium enema examinations, patients will be asked to pass out the barium and air in the bathroom. They may also clean up should there is any leakage of contrast media around the anus. Patients may experience constipation after the examinations. They are required to take in loads of fluid and high fibre food to prevent constipation so that any residual contrast media can be eliminated through defecation. Barium enema examinations can be exhausting. Patients are usually given a day off after the examination for them to rest. A cleansing enema may also be given to the patients to eliminate barium depending on their condition. Light colored stool should also be expected the next two or three days after the examinations.
Patient care is very important in barium enema examinations. Before the examinations start, the right patient is ensured to be summoned by checking on the name as well as registration number. Patients will then be briefed on the examination in details. Risk factors and complications which may occur have to be informed to the patients before getting their consent for the examinations. We must also make sure that the female patients are not pregnant before the examinations. Throughout the whole procedure, patients will be monitored closely for any reactions toward the contrast media administered. An emergency trolley has to be present at the examination room as well so that emergency situations can be handled immediately. Apart from that, any pain or discomfort complained by patients shall be taken seriously and we shall help patients so that they comfortable throughout the whole procedure. Upon completion of the examinations, patients are assisted to leave the room. For inpatients, they will be escorted back to their wards while an appointment will be scheduled for outpatients after the procedure.
Barium enema is a safe screening test used on a routine basis in imaging department. However, some patients may experience complications during the procedure. For patients who do not defecate daily, a small amount of barium that is left in the colon may "dry" out and this causes constipation. This can be overcome if patients maintain a high fibre and roughage diet as well as take in loads of fluid. Another complication is the leakage of barium into the peritoneal cavity when there is a perforation in the large bowel. This is dangerous and causes peritonitis which can be fatal if left untreated immediately. However, such complication is very rare as any leakage of barium can be detected under the direct vision through fluoroscopy. Treatment can be given immediately should there is any detection on barium leak. Patients who suffer from tachycardia (rapid heart rate), toxic megacolon, severe ulcerative colitis or a suspected perforation in the intestine is strictly be advised against undergoing barium enema examination.
Barium enema is an important medical procedure to determine the cause of pathological large intestine. It provides images on large bowel for diagnostic purposes so that treatment can be given. Patients who are about to undergo such examination must be well prepared to avoid any possible complication and also to produce a good quality film. Although such examination poses threat to patients as it uses radiation, this procedure is considered as useful as the benefits outdo the risks.