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Small Bowel Enema

Small Bowel Enema

The small bowel is a long and tortuous organ which makes it difficult to examine radiologically. Currently the best method for examining the small bowel is the small bowel enema. It permits good distension of the small bowel with barium of the appropriate density in a relatively short period of time. and has the effect of making any narrowing of the bowel more obvious as well as showing up signs of inflammation, ulceration and fistula formation optimally. It is particularly useful when Crohn's disease, adhesions and tumours are suspected clinically.

The examination commences with the administration of local anaesthetic to the nostril and nasal passage on one side. A thin pipe (thinner than a pencil) is then introduced into the nose and passed down the oesophagus, through the stomach and round the duodenal loop to the very beginning of the small bowel. There is a sensation of pressure at the back of the nose while the pipe is being positioned and once pipe manipulation has ceased most patients are fairly comfortable.

Once the pipe has been satisfactorily positioned dilute barium is run through the pipe faster than one could possibly drink it. This allows optimal distension of the bowel and is not uncomfortable. When barium is noted to be entering the colon a series of X-rays of the entire abdomen is taken as well as a series of spot films of the terminal ileum and any area of abnormality. The pipe is then easily removed and further X-rays may be taken.

The entire examination from the administration of the local anaesthetic till the last X-ray usually takes about an hour. The tube is usually in place for at least 30 minutes. As the barium is dilute there is seldom any difficulty with spontaneous clearance from the bowel. Most of the barium is evacuated over the following 2-3 hours.

 

Preparation for a small bowel enema
The test is best done after being nil per mouth from midnight the night before so the there is no food material or excess fluid in the bowel. It is also advantageous to take a mild laxative the night before to clear the colon as a full caecum tends to slow down the onward flow of barium. Clear instructions will be given at the time of booking the examination.

 

 Always inform the radiographer and radiologist of any medical conditions and allergies. Female patients must inform our staff if they are pregnant.

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