Most part of gastrointestinal tract are comparable in density with those tissue surrounding them, some type of contrast medium must be added to visualize these structure. Barium enema also called as lower gastrointestinal tract is an examination to demonstrate the structure of the colon. This examination is used to diagnose disease or other problems that are affected the colon. This examination will evaluates the structure of the large intestine such as ascending colon, descending colon, sigmoid, transverse colon and the rectum. The barium will be poured into the rectum using a tube. The barium that is inserted into the rectum will block the x ray and causing the barium-filled colon to show up clearly on the radiograph image.
Types of barium enema
There are two type of barium enema that being used for lower GI track examination. There are double contrast or air-contrast study and single contrast study.
Double contrast study
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Double contrast barium enema is used to indicate in diarrhea and high-risk cases for example the patients with polyps, a family history of colorectal cancer, or a person history of cancer or rectal bleeding. This patient often receives an injection of a smooth-muscle relaxant such as glucagon immediately before the examination to relieve the bowel spasm. A typical routine for a double-contrast barium enema begins with the patient in a prone position and the table tilted slightly head-down. About 300ml of barium is instilled into the splenic flexure and air is then insufflated. This pushed the barium to fill the transverse colon. The bag is lowered, and the head of the table is raised to drain the rectum. This also traps barium in the transverse colon. The patient may be turned to the right side and more air added to bring barium around the hepatic flexure. The patient then turned to prone to bring the barium to the caecum. Once the colon is filled with barium and distended with air, various radiographic views are taken.
Single contrast study
Single contrast barium enema are indicated in certain situations like colon configuration, gross pathology, fistulas suspected, acute appendicitis or diverticulitis suspected and to reduce an intussusception. In a typical single-contrast barium enema, the suspension is run in slowly with the compression applied to the abdomen. About 1500ml of barium is required for the average adult barium enema. Spot views of the cecum, flexures and the sigmoid colon are taken. A variety of wise is taken. The excess barium is drained back into the bag, the tip is removed and the patient is sent to the toilet to evacuate as much of the barium as possible. A post evacuation film is taken, usually with the patient in the prone position. The barium sometimes removed by the gravity flow before the catheter tip is removed and air is then permitted to escape from the cuff. Then, the catheter is removed. When personification of the bowel is suspected, water soluble iodine compounds are the only acceptable contrast media. These compounds, such as Gastrografin, also are used in a variety of other vases on which administration of barium sulfate can prove hazardous. Water-soluble contrast agents are hypertonic, which means they draw fluid into the bowel. This can cause diarrhea and a sudden reduction in blood volume and is particularly dangerous in neonates and in patients with Hirschsprung disease. The patient is assisted to the toilet after the barium enema. Patients are often dehydrated as a result of the preparation for a barium enema. This can lead to a postural drop in blood pressure which could cause the patient to become dizzy and fall. It may be necessary to allow the patient to evacuate some of the barium into a bedpan before moving.
Indication Purpose and indication
Barium enema is used to detect any abnormalities of the colon or the rectum of patient such as tumors, inflammatory disease and other changes in the large intestines and also the rectum. Barium enemas are used to check bowel health and also diagnose the inflammatory of the bowel disease such as ulcerative colitis and irritable bowels syndrome (IBS) .Polyps also can be seen through the colonoscopy. The other problem such as diverticulosis (small pounches form on the colon wall that become inflamed on the colon).The other problem such as acute appendicitis or twisted loop of the bowel can also being seen. Annular pancrease, hirschprungs disease also the indication of this examination. The normal indication for doing barium enema is change in bowel habit, pain, mass, anemia and obstruction.
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The contraindication of this procedure include the toxic megacolon(double contrast barium enema is said to be no better than clinical judgments in this situation and is clearly more dangerous),pseudomembranous colitis, rectal biopsy with seven days and flexible endoscope within 24 hours, incomplete bowel preparation recent barium meal and it is advice to wait for 7-10 days, imminent abdominal bowel surgery, patient fraility,Rectal biopsy via flexible endoscope within previous 24 hours and rigid endoscope within previous 5 days. Ions
Before the procedure
Ask the patients whether she is pregnant or might be pregnant. Is she's not sure, ask the patient about the 28 days rule. Don't forget to ask whether the patient is allergic to latex. To administer the contrast material, latex products are commonly used. If the patient has the latex allergy, different product will be used. Allergic to the barium also are important for the radiographer to know. This is because; the examination will use barium as the contrast media.
Bowel preparation should be done 2 days prior to the date of the procedure. Try to take low fiber diet. Try do not eat meat, vegetables, fruits or milk product and avoid taking high fiber foods. On the first day of the preparation, tell the patient that what type of food that can they take. The examples are plain white bread, packet mee, fish and porridge. On the second days, patients are only allowed to take clear fluid such as glucose, ribena, Chinese tea any other fluids. Throughout the two days, drink a lot of water is very important because, patient will lose a lot of water when the medicine for clearing bowel takes effect. On the day or two day before the procedure, laxatives will be given to the patient that will help them pass motion. The patient will experience diarrhea, this is the effect of the laxative to clear the bowel. This laxative may come in different form like in fluid or pill. The imaging department will give this medication to the patient. The patient has to fasting 6 to 8 hours starting firm the midnight on the day before the examination. No food of fluids is allowed.
During the procedure
On the day of the examination, the staff will ask the patient what time they took the last food into their body. The staff also will make sure that the bowel has been prepared for the examination. The patient's lies on their left side with their knees and hips flexed and a lubricated catheter is inserted into the rectum. The catheter is then tape in place. The i.v of buscopan of 20mg or glucagon of 1mg which is a hypotonic agent is frequently given at this point to reduce bowel spasm. The bag or barium suspension is suspended on the drip stand about 1 meter higher than the patient. The patient remains on their left side and the table is tilted slightly. The clamp on the barium is released and the fluid slowly runs into the colon. The first phase of the study is to introduce enough barium and air to coat the bowel mucosa. Introduction of too much barium increases the like hood of barium reaching the caecum and refluxing into the terminal ileum where it will obscure sigmoid loops before spot images of the sigmoid can be recorded. Not enough barium will mean that the entire length of the colon will not coat. Under fluoroscopic assessment, flow of the barium is monitored. The patient will turn to prone position when the barium suspension reaches the splenic flexure until the barium has filled half of the transverse colon. At this point, patient turn back to left side with the bag put on the flow to enable excess fluid to drain back out the patient. Air or carbon dioxide is then gently insufflated into the rectum and the imaging sequence begins. This gas is insufflated throughout the procedure as required to ensure double contrast throughout. As the carbon dioxide absorbed by colon, it is more likely to require additional insufflation than air. Once the bowel is coated, several images will be taken in many ways like LPO and RPO of the rectum and sigmoid, prone and lateral rectum, RPO descending colon, supine or erect transverse colon, erect RPO splenic flexure, erect LPO hepatic flexure, and LPO descending colon and caecum. The duration for this procedure is depending on the speed of the barium to fill the area of interest. Numbers of images are required to properly evaluate the colon.
After the procedure
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Most people have a short recovery of time and can go home directly after the procedure is done. The images will be read by the radiologist with the help of the patient's doctor. The result will be told by doctor within in weeks. If there is any pathology, the doctor will find out the way to cure whether by the biopsy or surgery.
Examination for the lower GI tract is a minimally invasive procedure with very rare complication. This examination can often provide information to avoid more invasive procedures such as colonoscopy. This is because, barium is not absorbed into the blood, and there are very rare allergic reactions. With this examination, no radiations will remain in the patient's body and the x-rays usually have no side effect in the diagnostic range.
Peritonitis is one of the rare risks when doing the barium enema procedure. This is happen when the contrast material is perforating the colon and spill into the abdominal cavity. This will cause the colon to become narrow and become blocked. For those who have severe ulcerative colitis, toxic megacolon, and rapid heart rate should not undergo a barium enema. Several complications may occur are perforification of colon, water intoxication, barium granulomas and allergic reaction but these conditions are very rare.