BARIUM ENEMABARIUM ENEMA

• Double contrast

• Single contrast

METHODSMETHODS

INDICATIONSINDICATIONS

• Changes in bowel habit

• Colitis

• Ulcerative colitis

• Pain

• Mass

• Melaena/anaemia

• Diverticulum

• Intussusception (single contrats)

• Neoplasm

• Volvulus

• Obstruction

CONTRAINDICATIONCONTRAINDICATION

• Toxic megacolon

• Pseudomembranous colitis

• Rectal biopsy

• Incomplete bowel preparation

• Recent barium meal

• Patient frailty

CONTRAST MEDIACONTRAST MEDIA

• Positive CM:

– Barium sulfate

– Amount : 500 ml

• Negative CM:

– Double Contrast Barium Enema (DCBE)

– Carbon dioxide, room air

EQUIPMENTEQUIPMENT

• Fluoroscopy unit with spot film device

• Miller disposable enema tube

• Barium enema bag

• Clamp/forceps

• Lubricant

• Plaster

PATIENT PREPARATIONSPATIENT PREPARATIONS

• Bowel preparation → 2 days

– 1st day →low residual diet

– 2nd day →fluid only & laxative

• LMP / ? Pregnant

FILMS: preliminaryFILMS: preliminary

• AXR

→assess bowel preparation

→necessary when toxic megacolon is suspected

TECHNIQUE: DCBETECHNIQUE: DCBE• Pt lies in lateral position

• Catheter is inserted into rectum gently & taped firmly in position

• Hand pump is connected

• i.v of Buscopan (20mg) / Glucagon (1mg) is given

• Pt lies in prone position

• Infusion of barium is commenced. Intermittent screening is required

• Infusion is terminated once the barium reaches hepatic flexure

• The barium is turn back out by either lowering the infusion bag or tilting the table erect

• Air is gently pumped into the bowel, forcing the barium round toward caecum & producing double contrast effect

• From prone position, pt rolls onto left side & over into RAO position so that barium coats the bowel mucosa

FILMS: spotFILMS: spotSpot films of rectum &

sigmoid (table horizontal)

• RAO• Prone• LPO• Left lat. of rectum

Spot films of hepatic flexure (table erect)

• LAO• RAO• Right lat. of the rectum

Spot films of caecum (table horizontal)

• Supine; slightly on right side (slightly LAO) ; head down

• Overcouch – AP SUPINE

– PA PRONE

– HAMPTOM :- prone with tube angle 45° caudad & center about 5cm above PSIS

– RIGHT LATERAL DICUBITUS

– LEFT LATERAL DICUBITUS

FILMS: post FILMS: post procedureprocedure

AFTER CAREAFTER CARE• Warn pt that bowel motion will

be white for a few days

• Laxative is given to avoid barium impaction

• Pt must not leave the department until blurring vision has resolved

• Advise pt to increase intake of fluid, fruits & vegetables

COMPLICATIONSCOMPLICATIONS

• Perforation of the bowel

• Transient bacteraemia

• Cardiac arrhytmia due to rectal distension

• Side effect of pharmacological agents used

• Venous intravasation