Filia D.

Yaputri
A 34
Barium Enema

I. Introduction
Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine,
also known as the colon. This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon, the
sigmoid colon and the rectum. The appendix and a portion of the distal small intestine may also be included.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-
rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the
oldest and most frequently used form of medical imaging.
The lower GI uses a special form of x-ray called fluoroscopy and a contrast material called barium or a water-soluble iodinated
contrast. The barium enema is occasionally used to assess filling pf the appendix. When the clinical picture suggests possible appendicitis,
failure of the appendix to fill with barium may support the diagnosis. Although the colon is the main organ evaluated by a barium enema,
reflux of barium into the terminal ileum also allows adequate visualization of the distal part of the small intestine. Diseases that affect the
terminal ileum, especially Crohn disease (regional enteritis), can be identified. Inflammatory bowel disease involving the colon can be
detected with barium enema. Fistulas involving the colon can be demonstrated by barium enema.

II. Indication/ Purposes

Barium enema is used to evaluate bowel changes and abdominal pain, to detect benign tumors such as polyps, cancer, ulcerative
colitis (inflammatory bowel disease), to detect Hirschsprung disease in children (a blockage of the large intestine). Exclude obstruction,
polyps, diverticula, or other masses, fistula, and inflammatory changes.

III. Contraindications
Contraindicated for patients with:
 Suspected of a perforation of the colon
In these patients, diatrizoate (Gastrografin), a water-soluble contrast medium is used.
 Patients with megacolon.
Barium may worsen the disease.
 Patients who are unable to cooperate
This test requires the patient to hold the barium in the rectum and colon. This is especially difficult for elderly patients.

IV. Normal findings/ Normal values

Normal position, contour, filling, movement time, patency of the large bowel and colon, and appendix size and position.

V. Procedure
 The patient lies on his or her side of the exam able and is given a contrast agent (usually barium) in the form of an enema through
the rectum (i.e., up through the sigmoid, descending, transverse, and ascending colon) or through a stoma. Under fluoroscopy,
the colon is completely filled to the ileocecal junction. For a satisfactory examination, the contrast-filled coon must be maintained
for several minutes while x-ray films are taken. In most instances, air is also introduced into the colon (i.e., air contrast or double
contrast enema).
 The patient is instructed to retain barium while spot films are taken with the patient in a variety of positions. A post evacuation film
can also be taken to document colon emptying. Total examination time is approximately 30minutes.
 Defecography requires the patient to evacuate into a specially designed commode while being evaluated fluoroscopically.

VI. Nursing Responsibilities

A. Before the procedure:
 Assess for test contraindications (usually pregnancy). Explain the examination purpose and procedure. No food or
beverage is allowed for approximately 6-8 hours before the study.
 Make certain that jewelry and metallic objects are removed from abdominal area.
 Special attention is necessary for diabetic patients. Because of the test fasting, the administration of insulin or some oral
hypogly pre cemic agents may be contraindicated for the day of and several days after the test.
  Bowel preparation routines vary (usually a three-step process) over 1-2 days and may involve any combination of diet
restrictions preceding the test, mechanical cleaning with enemas and physio- logic stool softeners, or cleaning with
laxatives
B. During the Procedure
 Inform the patient that abdominal bloating and rectal pressure will occur during installation of barium.
C. After the procedure
 Provide fluids, food, and rest after study. Administer laxatives for 1-2 days or until the stool returns to normal.
 Observe and record stool color and consistency to determine if all barium has been eliminated from the bowel.
 Evaluate outcomes, and provide the patient with support and counselling about further tests and possible treatment.

VII. Significant Findings and Interpretation

Interfering factors:
1. Delays in small intestine motility can be due to the following circumstances:
a. Morphine use
b. Severe or poorly controlled diabetes
c. Retained fecal material caused by poor or inadequate bowel cleansing.
2. Increase in motility in the small intestine can be due to the following circumstances:
a. Fear or anxiety
b. Excitement
c. Nausea
d. Pathogens
e. Viruses
f. Diet (e.g., very high fiber)
3. Inability of the patient to maintain contrast-filled colon long enough to allow complete examination.
4. Spasm of the colon can mimic the radiographic signs of a cancer
5. Severe obesity adversely affecting image quality.

Abnormal findings:

Malignant tumor, polyps, diverticula, Inflammatory bowel diseases (e.g., ulcerative colitis, Crohn disease), colonic stenosis secondary to
ischemia, infection, or previous surgery, perforated colon, colonic fistula, appendicitis, extrinsic compression of the colon from extracolonic
tumors (e.g., ovarian), extrinsic compression of the colon from the abscess, malrotation of the gut, colon volvulus, hernia, intussusception.

Abnormal small bowel x-ray results indicate the following conditions:

1. Anomalies of small intestine

2. Errors of rotation
3. Meckel’s diverticulum
4. Atresia
5. Neoplasms
6. Regional enteritis
7. Tuberculosis
8. Malabsorption syndrome
9. Intussusception
10. Roundworms (ascariasis)
11. Intra-abdominal hernias

VIII. Complications
 Colonic perforation, especially when the colon is weakened by inflammation, tumor, or infection
 Barium fecal impaction
IX. References
Fischbach, F., Fishbach, M. (2016). Nurse’s Quich Reference to Common Laboratory & Diagnostic Tests 6 th edition Page 110-11
Mosby’s Diagnostic & Laboratory Test Reference (2015) 12th edition Page 132 – 135

Fischbach, F., Fishbach, M. (2018). Fischbach’s A Manual of Laboratory and Diagnostic Tests 10 th edition page 730- 733
Fishbach, M., Dunning, M., (2015). A Manual of Laboratory and Diagnostic Tests 9 th edition page 747– 750

WebMD (2019). What is a Barium Enema? Retrieved from https://www.webmd.com/a-to-guides/what-is-a-barium-enema#1

Peate, I (2017) Tests, scans and investigations, 12. Barium enema retrieved from https://doi.org/10.1296 8/bjha.2017.11.7.318

Yoo, H., Son, J., Park, H., (2016) Value of 24-hour Delayed Film of Barium Enema for Evaluation of Colon Transit Function in Young Children
with Constipation retrieved from https://doi.org/10.5056/jnm15128

Peyvasteh, M., Askarpour ,S., Ostadian, N., (2016) Diagnostic Accuracy of Barium Enema Findings in Hirschsprung’s Disease retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074665/