Preparing the colon for the barium enema examination
The colon is frequently examined by using a barium enema. The barium helps in imaging the colon when it is X-rayed. Although the procedure has been in use for many years, controversy still exists about how best to prepare the patient being examined with this technique. An accurate barium enema examination requires a clean colon, and this article reviews methods to prepare the colon for examination. Patients are often put on a 24-hour liquid diet to reduce production of fecal material. Cathartics (laxatives) are given to promote defecation; both saline (salt) and irritant cathartics are used. Saline cathartics help draw fluid into the intestines, which increases intestinal peristalsis (rhythmic movement that propels the fecal material). Irritant cathartics, such as castor oil, increase intestinal activity and are often given in combination with saline cathartics. A cleansing enema is the final procedure given before examination; it is important for removing any residual fecal matter. It is now recommended that only warm tap water be used for this procedure. The procedure requires great care and often must be repeated. Once this has been completed, there should be a waiting period of 30 to 60 minutes before the barium enema is given so that excess water can be absorbed. The cleansing enema is important diagnostically in seeing if the patient's colon is sufficiently clean to be examined, and to see if the patient has sufficient sphincter control to retain the barium enema. The authors recommend that preparation for a barium enema should begin with a 24-hour clear liquid diet, followed by a combination of the saline cathartic, magnesium citrate, and the irritant cathartic, castor oil. The patient should then carefully be given a cleansing enema on the morning the barium enema is to be given. This procedure results in a very high success rate for barium enema examinations. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Radiology
Incarcerated obturator hernia: case diagnosed at barium enema fluoroscopy
An obturator hernia occurs when a loop of small intestine passes through a normally occurring hole (foramen) of the bony pelvis. In this condition, the connective tissue and muscle which should close this space (the obturator foramen) is defective. As with all hernias, the possibility exists of incarceration (sometimes called 'strangulation'), which is the inability to return the gut to the abdomen with a resulting loss of flow of intestinal contents and blood flow to the area. Incarceration of the obturator hernia is rare, potentially lethal if untreated and difficult to diagnose. The condition is diagnosed before surgery in only approximately one-third of the patients. An 87-year-old woman with loss of appetite, nausea, abdominal pain, weight loss and mild retention of stool was examined. She received a barium enema (an enema with a barium dye, which can be seen on X-ray). The X-ray showed a lack of filling of barium in the upper portion of her intestine and the filling seemed to end in the thigh at the obturator foramen. During surgery the diagnosis of incarceration of the bowel was confirmed. Early diagnosis of this condition is important as it most frequently occurs in aged women who may be in generally poor health. Delay in surgical treatment has contributed to the high rate of morbidity and mortality associated with this condition.
Publication Name: Radiology
Procedures for giving a patient an enema containing liquid barium is described. The barium enema is useful as a contrast media to enhance x-rays of the colon and rectum.
Publication Name: Nursing Times
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