Barium Enema

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Overview

Barium enema (BE) is a test most people would like to avoid. The truth is, if done properly, a barium enema need not be an awful ordeal. Basically the barium enema is a fluoroscopic test used to study the large bowel, or colon.

There are two basic types of barium enemas: The regular, or single contrast, barium enema and the air contrast barium enema. The regular, or single contrast, barium enema is performed using only barium; the air contrast barium enema uses barium and air together.

When Is a Barium Enema (BE) Necessary?
The indications for barium enemas remain a controversial issue. Colonoscopy, which involves inserting a fiber optic tube into the rectum and passing it through the large bowel, has taken over as the definitive way of examining the large bowel. That test, though significantly more costly than the BE, is generally considered more accurate.

Its real advantage is the ability to biopsy and even remove polyps (small growths that are usually noncancerous, but not always) through the same tube. Sedation is generally needed and, when effective, causes complete amnesia of the event, which is a good thing.

Though not the "gold standard," BE is considered an excellent test for finding cancers of the colon, for looking at various inflammatory conditions such as diverticulitis, and for discovering polyps, especially with the air contrast technique. Now and then, the radiologist may be asked to actually treat a condition known as intussuseption.

In this rare situation, the end of the small bowel rolls into the beginning of the large bowel. One tube slides inside the other, so they block each other. The remedy is pressure from the outside to push the inside tube back out of the outside tube (reduce the intususseption).

Alternatives
Colonoscopy is the principle alternative to BEs. Patients who are too debilitated, or are unable to cooperate enough to have BEs, can have alternative abdominal and pelvic CT scans that detect major large bowel pathology. There is a very new and exciting test called virtual colonoscopy that allows the radiologist to examine the large bowel almost like a computer game.

Risks and Potential Complications
The good news is that there are few complications to barium enemas. Most complications arise from the insertion of the enema tube and the inflation of the little balloon at the enema tip. Very rarely, patients may be allergic to the latex in the balloon. Overinflation of the balloon can result in tearing of the rectal wall, which can be a very serious complication. This complication is most apt to occur when the lining of the rectum is inflamed, such as in ulcerative colitis. It would be very unusual to overinflate a normal rectum.

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