Estimated time: Two hours
Anatomy involved: Large bowel or colon Performed by: Radiologist (physician), technologist, fluoroscopy assistant Preparation: Patients with ostomies having gastrointestinal studies should bring extra bags on the day of the examination.
A barium enema (BE), or single contrast barium enema, is an 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 thirty minutes before your exam begins. A preliminary X-ray of the abdomen will 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 lead you into a fluoroscopy room, give you a brief explanation of what you can expect, and prepare you for the test by inserting a small tube into your rectum. A radiologist will enter the room and 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 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 can tolerate the mild discomfort. The radiologist will then have you move in different positions so that the barium will fill the large bowel. During the exam, a medication called glucagon may be administered by injection. Its purpose is to relax the bowel muscles thereby reducing motion and minimizing possible cramps experienced by the patient. 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 exam to better visualize certain structures. When the radiologist is finished, the technologist will then take a series of X-rays while you are placed in varying positions on the X-ray table. While the radiologist reviews your images, you will be taken to the bathroom to evacuate the enema, after which a final X-ray will be taken and the radiologist will interpret the complete set of images.
Upon completion of the 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 exam. 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. In rare instances, the barium can cause temporary constipation, which is usually well treated with an over-the-counter laxative. A variant of the single contrast barium enema examination is the barium enema via colostomy. In this instance, the patient's colostomy stoma is accessed via a small catheter appropriate to the size of the stoma, and a small balloon on the catheter tip is inflated to hold the catheter in place. The remainder of the examination is similar to that previously described. 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.