BARIUM ENEMA

METHODS

• Double contrast
• Single contrast
 INDICATIONS
• Changes in bowel • Diverticulum
habit
• Intussusception
• Colitis
(single contrats)
• Ulcerative colitis
• Neoplasm
• Pain
• Volvulus
• Mass
• Melaena/anaemia • Obstruction
 CONTRAINDICATION

• Toxic megacolon
• Pseudomembranous colitis
• Rectal biopsy
• Incomplete bowel preparation
• Recent barium meal
• Patient frailty
 CONTRAST MEDIA
• Positive CM:
– Barium sulfate

– Amount : 500 ml

• Negative CM:
– Double Contrast Barium Enema
(DCBE)

– Carbon dioxide, room air

 EQUIPMENT
• Fluoroscopy unit with spot film device
• Miller disposable enema tube
• Barium enema bag
• Clamp/forceps
• Lubricant
• Plaster
 PATIENT PREPARATIONS

• Bowel preparation → 2 days

– 1st day →low residual diet

– 2nd day →fluid only & laxative

• LMP / ? Pregnant
 FILMS: preliminary
• AXR

→assess bowel preparation

→necessary when toxic

megacolon is suspected
 TECHNIQUE: 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: spot
Spot films of rectum & sigmoid
Spot films of hepatic
(table horizontal) flexure (table erect)
• RAO • LAO
• Prone • RAO
• LPO • Right lat. of the rectum
• Left lat. of rectum

Spot films of caecum

(table horizontal)

• Supine; slightly on right

side (slightly LAO) ;
head down
 FILMS: post procedure

• Overcouch
– AP SUPINE
– PA PRONE
– HAMPTOM :- prone with tube angle 45°
caudad & center about 5cm above PSIS
– RIGHT LATERAL DICUBITUS
– LEFT LATERAL DICUBITUS
 AFTER 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
 COMPLICATIONS
• Perforation of the bowel

• Transient bacteraemia

• Cardiac arrhytmia due to rectal

distension

• Side effect of pharmacological

agents used

• Venous intravasation