Type of test: X-ray with contrast dye

Normal findings

Normal filling, contour, patency, and positioning of barium in the colon

Normal filling of the appendix and terminal ileum

 Test explanation and related physiology

The BE study consists of a series of x-rays with contrast to visualize the colon. It is used to demonstrate the presence and location of polyps, tumors, and diverticula. Anatomic abnormalities (e.g., mal rotation) also can be detected. Therapeutically, the BE may be used to reduce nonstrangulated ileocolic intussusception in children.

By reflux of barium in the terminal ileum, Crohn disease (regional enteritis) can be identified. Inflammatory bowel disease involving the colon can be detected with a BE. Fistulas involving the colon can be demonstrated by a BE.

 In many instances, air is insufflated into the colon after the instillation of barium. This provides an air contrast to the barium. With air contrast, the colonic mucosa can be much more accurately visualized. This is called an air-contrast BE and is more accurate than single contrast barium enema.

 Contraindications

 • Patients suspected of a perforation of the colon In these patients, diatrizoate (Gastrografin), a water-soluble contrast medium, is used.

• Patients with megacolon because barium can worsen this condition

 Potential complications

 • Colonic perforation, especially when the colon is weakened by inflammation, tumor, or infection

 • Barium fecal impaction

Interfering factors

 • Barium within the abdomen from previous barium tests

 • Significant residual stool within the colon may be confused with polyps.

Procedure and patient care

Before Explain the procedure to the patient. Encourage the patient to verbalize questions and fears. See p. xviii for radiation exposure and risks.

• Assist the patient with the bowel preparation, which varies among institutions. In elderly patients, this preparation can be exhausting and may even cause severe dehydration. A typical preparation for most adults would include the following actions:

Day before examination

• Give the patient clear liquids for lunch and supper (no dairy products).

* Instruct the patient to drink one glass of water or clear fluid every hour for 8 to 10 hours.

• Administer a cathartic (10 oz of magnesium citrate) or X-Prep (extract of senna fruit) at 2 pm. In children, lesser volumes may be used.

• Administer three 5-mg bisacodyl (Dulcolax) tablets at 7 pm.

• A pediatric Fleet enema the night before testing and repeated 3 hours before testing may be adequate prep for an infant.

 • Keep the patient NPO (nothing by mouth) after midnight the day of the test.

 Day of examination

• Keep the patient NPO.

 • Administer a bisacodyl suppository at 6 am and/or a cleansing enema.

 • Note that pediatric patients will have individualized bowel preparations.

 • Note that special preparations will be ordered for patients with an ileostomy or colostomy.

 • Determine whether the bowel is adequately cleansed. When the fecal return is similar to clear water, preparation is adequate; if large, solid fecal waste is still being evacuated, preparation is inadequate. Notify the radiologist, who may want to extend the bowel preparation.

* Suggest that the patient take reading material to the x-ray department to occupy the time while expelling the barium.

 During

• Note the following procedural steps:

1. The test begins with placement of a rectal balloon catheter.

2. The balloon on the catheter is inflated tightly against the anal sphincter to hold the barium within the colon.

3. The patient is asked to roll into the lateral, supine, and prone positions.

4. The barium is dripped into the rectum by gravity.

 5. The barium flow is monitored fluoroscopically.

 6. The colon is thoroughly examined as the barium flow progresses through the large colon and into the terminal ileum.

 7. The barium is drained out.

 8. If an air-contrast BE has been ordered, air is insufflated into the large bowel.

 9. The patient is asked to expel the barium, and a postevacuation x-ray image is taken.

 • Note that this test is usually performed in the radiology department by a radiologist in approximately 45 minutes.

* Inform the patient that abdominal bloating and rectal pressure will occur during instillation of barium.

After

 • Ensure that the patient defecates as much barium as possible.

* Suggest the use of soothing ointments on the anal area to minimize any anorectal pain that may result from the test preparation.

* Encourage ingestion of fluids to avoid dehydration caused by the cathartics.

* Inform the patient that bowel movements will be white. When all the barium has been expelled, the stool will return to a normal color.

 • Note that laxatives may be ordered to facilitate evacuation of barium.

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 an abscess

- Malrotation of the gut

- Colon volvulus

- Intussusception

- Hernia