Barium Enema
= Colon in Loop
The routine examination of the colon
Technique :
• Single Contrast : barium suspension
• Double Contrast : barium susp.+ gas
Radiology Anatomy
• Gas pain
• Colonic perforation or colonic ruptur
• Water intoxication
• Colonic intramural barium
• Rectal laserasion
• Bactery contamination
• Allergy / hipersensitivitas of barium or
glukagon/buscopan
Preparation
Patient preparation
2
1
4
2
Technique & positioning
A.
Left lateral position :
contrast filling
rectum and
rectosigmoid
B.
Left posterior
oblique (LPO):
contrast filling
sigmoid
C.
Left lateral with 15o
Trendelenberg position :
contrast flow to descendent
colon and lienalis flexure
D.
Clockwise to prone position:
contrast filling transversal
colon
E.
Clockwise to right lateral
with 15o Trendelenberg
position : contrast filling the
hepatic flexure
F.
From E, turn left to supine
position : contrast filling
hepatic flexure and
ascendant colon
G.
Turn to left posterior oblique
(LPO) to filling the
ascendants colon
H.
From G position, turn
clockwise to supine
position: contrast filling the
caecum
Recording / filming
Whole colon :
overhead film
Overhead film
Barium
Enema
Double
Contrast
Spot film : double contrast
Hepatic flexure
- Redundant colon
- Decubitus to right side
(RLD)
- Horizontal ray
- Clearly evaluated :
lateral of descendant
and medial of
ascendant colon
Others position (if needed)
- Redundant colon
• Decubitus to left side
- Horizontal beam
• Clearly evaluated : lateral of
ascendant and medial of
descendant colon
Single contrast vs Double contrast
SC DC
• Motility (+/-).
• Contour and mucosa (++)
• Difficult technique
Motility study (++).
Bowel contour (++),
mucosa (-)
Simple technique.
False-positive findings :
Bubble
Pedunculated Polyp
Sessile Polyp
En profile view
En face view
En profile view
Colonic diverticulosis
Caecum
Terminal ileum
Rectal Ca.
• Barium enema lateral view.
• The lumen of the rectum is narrowed
severely by the circumferential mass
with mucosal destruction and the
overhanging edges or shouldering at the
tumor margins.
Colonic polyp
Filling defect on single contrast Soft tissue mass on double contrast
Extraluminal tumor