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Double Contrast Barium Enema

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In a double-contrast barium enema, a fine coating of thick barium is needed to outline the mucosal lining of the bowel. The patient will be placed prone so that gravity can assist the air in distributing the liquid around the large bowel. The patient is asked to turn over 360 degrees a few times during the exam to aid in the coating of the bowel. The patient is then placed upright, and more air is injected into the bowel so gravity again can assist in visualizing the large intestine. Patients may develop spasms of the bowel during this exam, so the radiologist may give the patient a glucagon injection to relax the large bowel. This injection should not be given to patients with a history of glaucoma and can cause temporary double-vision in these patients.

The radiologist will take spot-films under fluoroscopy of each segment of the bowel but most of the films will be made following the procedure by the x-ray technologist. Since less barium is used along with some air, less kilovoltage (90-100kvp) is needed to achieve a high contrast x-ray of the large intestine. The usual AP and PA (posteroanterior) abdomen films will be done as well as the two oblique views of the abdomen. An upright film may be done as well depending on the routine of the radiologist. The most important films for the double-contrast exam are the two lateral decubitus films. The patient is placed on a large cushion or sponge and turned completely onto one side. A stationary grid is placed next to the patient and the x-ray tube is turned 90 degees. This film allows the air to rise to the upper surface of the abdomen so that the air along with the thin coating of barium creates a detailed visualization of the intestinal lining. This is extremely important when looking for small polyps, cancers, and ulcerations of the bowel. Films of both sides are always taken.


Double contrast barium enema equipment


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