Anatomy involved: Large bowel or colon
Performed by: Radiologist (physician), technologist, fluoroscopy assistant
Preparation: Diet, magnesium citrate, dulcolax tablets. Patients with ostomies having GI studies should bring extra bags on the day of examination.
An air contrast barium enema is a detailed X-ray examination of the large bowel or colon.
A fluoroscopy assistant will give you a clear water-cleansing enema to ensure a clean bowel at least 30 minutes prior to the start of the exam. An X-ray of the abdomen will then be obtained to determine the adequacy of the bowel preparation. In rare instances, if the bowel preparation has not adequately cleaned the bowel, your exam may be rescheduled for the following day after continuing the preparation for another 24 hours, or for sometime in the future. A fluoroscopy assistant will then bring you into a fluoroscopy room, give you a brief explanation of what you can expect, and insert a small tube into the rectum in preparation for the exam. A radiologist will begin the exam by inflating a small balloon on the enema tip to hold the tube in place. You may feel slight pressure as the balloon is inflated, but it will pass. A thick barium solution is then introduced into the colon via the enema tip. The inflated balloon on the enema tip is specially designed to help you hold the barium in the rectum. As the barium fills your colon, you may feel the need to move your bowels. You may also feel abdominal pressure or possibly even minor cramping. These are common sensations and most patients tolerate the mild discomfort without difficulty. The radiologist will then have you move in different positions so that the barium will coat the walls of the bowel. Some of the barium is then removed, and air is then introduced into the bowel also via the enema tip. This air distends the bowel allowing for ideal visualization of the walls of the colon. During the exam, a medication called glucagon is often administered by injection. Its purpose is to relax the bowel muscles thereby reducing motion and minimizing possible cramps experienced by the patient due to the administration of air. As the test proceeds, the radiologist will take "spot" films or small X-rays of particular areas. The radiologist may also apply mild focal pressure to parts of your abdomen during the examination to better visualize certain structures. In addition, the X-ray table may be put in an upright position to better evaluate certain parts of the colon. When the radiologist is finished, the technologist will also take a series of X-rays, re-positioning you for certain views. After the images are quickly reviewed by the radiologist, you will be taken to the bathroom to evacuate the enema. A final X-ray may be taken after evacuation and then the complete set of images will be interpreted by the radiologist.
Upon completion of the Radiologist's interpretation, you will be instructed to proceed with your chart to your next appointment. You will be able to return to your normal diet and activities after the examination. Your stools may appear white for a day or so as your body clears the barium from your system. You are encouraged to drink additional water for 24 hours after the exam to help pass the barium. If you encounter any problem in following these instructions, or if a situation arises that does not appear to be covered here, please call your Lahey physician at (781) 744-5100.