What is the barium enema
The barium enema is a radiological examination of the large intestine (colon, sigmoid and rectum). In order to make this region clearly visible, it is necessary to introduce an appropriate contrast agent rectally through the anus. The patient, for his part, must carefully respect certain indications both during the examination and in the three days preceding it.
Why It Executes
Barium enema is a medical procedure performed to examine and diagnose large bowel problems. Its applications, partly limited by the advent of colonoscopy, range from the investigation of particular symptoms (rectal bleeding, chronic diarrhea, alterations of the alvus, abdominal pain), to the diagnosis of specific diseases or alterations, such as stenosis, intestinal obstructions, polyposis, alterations in the motility of the viscera, diverticulosis and colon cancer. Compared to the barium enema, colonoscopy has the great advantage of not using ionizing radiation and providing more accurate information, since it can be associated with the removal of a small amount of tissue abnormal (biopsy) However, this is a more invasive examination.
How to do it
To assess the health of the colon, the radiologist has two main techniques at his disposal: the conventional barium enema and the double-contrast barium enema. In both cases it is necessary to introduce an appropriate radiopaque contrast agent rectally, generally barium sulphate, since in its absence the radiographic image would not allow any type of diagnosis to be made.
A well-lubricated tube is then inserted into the rectum and once in place, the contrast medium is gradually released. The filling operation can be facilitated by the insufflation of air into a small balloon placed on the tip of the probe, in order to favor the retention of the barium inside the colon. All this takes place under radioscopic control by the specialist. introducing the probe, a first X-ray is performed to ensure that the colon is well cleaned.
The various filling maneuvers determine a stimulus for evacuation, sometimes intense, which must be controlled until the personnel is given the green light. Received the ok, the enema can be evacuated and once the intestine has been emptied it is necessary to undergo further radiographs. Overall, the test is generally well tolerated and only mildly bothersome.
In the double-contrast barium enema, after evacuation, air is blown into the colon in order to stretch the walls and generate better quality images, capable of showing even very limited alterations. For this reason, the double-contrast barium enema is generally preferred to the colon. conventional technique.
To facilitate the distension of the intestinal viscera and reduce discomfort, antispasmodic drugs are sometimes given by injection.
Whatever procedural technique is adopted, the examination requires the execution of radiographs in different positions to observe the various sections of the intestine.
Duration
The duration of the barium enema is very variable and depends on the conditions and cooperation of the patient, as well as on the type of equipment used; on average, the exam lasts from 20 to 40 minutes.
Prepare for the exam
The barium enema diet
The preparation of the patient for the barium enema begins a few days before the examination, during which it is recommended to adopt a diet low in waste to eliminate solid and liquid fecal residues that would prevent a correct observation of the colon.Whole foods, fruits, vegetables, legumes, bread, pasta, sugar, wine, liqueurs and fatty foods will therefore be removed. Grilled meat, boiled fish, broth, rice and hard-boiled eggs are allowed and recommended. The day before the examination, the diet - particularly light and almost exclusively liquid - will be integrated with suitable laxative preparations as prescribed by the doctor.
Contraindications
Barium enema is generally not performed in pregnancy, whether certain or suspected, as X-rays can cause harm to the unborn child. If you suffer from heart disease, diabetes, glaucoma or allergies, it is a good rule to communicate this to the staff before the examination. Any medicines taken must be communicated at least one week before the appointment.
Although this is not a high-risk procedure, there is a remote possibility of perforation of the intestinal wall when the air is blown, especially in the presence of diverticula. In this case, closure surgery must be performed. they can occur during examination, especially in patients with hemorrhoidal plexus varices.
There is no particular prescription or precaution to be observed after performing the barium enema. Some medications, sometimes administered during the examination, can cause some transient vision problems; in this case it is not recommended to drive. During the day, a feeling of discomfort or fullness may persist, which resolves spontaneously with rest and subsequent evacuations, during which the residual barium is eliminated which gives the stool a whitish color. Since the barium used during a barium enema can cause constipation, it is important to drink plenty of fluids in the following days; if this is not enough, the doctor may possibly prescribe a laxative.
Barium enema cannot and must not be performed using barium contrast medium if there is suspicion of intestinal perforation and / or haemorrhage, since barium is not absorbed by the body and should therefore be eliminated by surgery. Its use is not recommended even in the presence of diverticulosis, due to the greater risk of perforation during the test. In these cases, the barium enema is performed using an iodized, soluble and resorbable contrast agent.
