Barium Small Bowel Enema

Basic Anatomy

Barium small bowel enema is designed to demonstrate the small bowel from the
duodenum to the ileo ceacal region encompassing the duodenum, jejunum and ileum including the junctions superiorly with the stomach and inferiorly with the ascending colon.
By passing a tube through the stomach and introducing the contrast media directly into the duodenum, a better flow and coating of contrast media is achieved as well as reducing the risk of the stomach overlying regions of interest.

Indications

Abdominal pain
Diarrhoea
Bleeding
Partial obstruction
Investigations of transit time
? Mekels diverticulum

Contraindications

Obstruction
Imminent surgery and or suspected perforation require water soluble contrast media.
Contrast Media and drugs. (Typical Examples, See Contrast / Drugs Section for more information)
Baritop 100 w/v 300mls diluted with 700mls water.
Metaclopramide
Anaesthetic spray or lozenge

Equipment

Fluoroscopy with rapid film capability 10 frames/second
Fluoroscopy table with 90/20 tilt.
Nasogastric (e.g. Bilbao Dotter tube) feeding tube + administration equipment,
Injection administration equipment.

Patient Preparation

Patient Identification, Check Pregnancy state,
General psychological preparation and examination outline.
Low residue diet and laxatives for 48 hours before the examination.
* Note special preparation may be needed for diabetic patients.
Check sensitivity to drugs used.
The upper administration route is topically anaesthetised 15 minutes before insertion of the naso-gastric tube.
The duodenum is intubated, either nasally or orally.

Technique

The tube is passed into the stomach and maneuvered under fluoroscopic control into the duodenum using a guide wire inserted into the tube, it is passed sufficiently far to reduce the risk of the contrast agent refluxing back into the stomach.
The barium mixture is then introduced down the tube either using gravity feed from a suspended bad or using a wide bore syringe, a flow rate of 1 liter in about 10 minutes producing good results.
Metaclopramide may be given to speed up transit time in some patients.
When all the contrast has been administered the tube is withdrawn and the stomach contents aspirated to reduce the risk of aspiration.

Typical Film Series

Spot films are taken as required.
Supine and Prone full length abdominal films may be taken at the end of the procedure.

Typical Film from Image Series

Radiation Protection

Define strict referral criteria to exclude clinically unhelpful examinations
Minimise fluoroscopy time and current
Introduce QA programme to make regular checks on and to optimise staff and equipment performance
Collimate X-ray beam to minimise size
Shield sensitive organs when possible
Install modern image intensifiers with sensitive (e.g. CsI) photocathodes and digital image processing
Use video recorder instead of cine camera during fluoroscopy wherever possible
Use spot film photofluoroscopy with modern image intensifier and 100mm camera instead of radiography whenever appropriate
Use pulsed systems with image storage devices in fluoroscopy.

Aftercare

Record volumes and descriptions of contrast media and drugs administered.
General patient psychological aftercare
Ensure the patient understands the procedure for collecting the results.
Warn the patient of the possibilities of constipation and appropriate counter measures.
The patient should have nothing to eat or drink for 5 hours after the procedure, or until the affects of the topical ,local anaesthesia have completely worn off.

Complications

Aspiration of barium mixture
Leakage of barium into the peritoneum with and unsuspected perforation
Other Imaging Techniques
Radio nuclide Imaging for GI Bleed
CT.
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