Applies to Air Contrast Study of Colon

Indications Evaluate the colon for presence of embolism, aneurysm, neoplasms, hemorrhage, or atherosclerosis

Contraindications Known perforation of the colon

Patient Preparation Adequate bowel preparation is the key to the performance of a diagnostic barium enema. For appropriate preparation of the bowel we use a polyethylene glycol electrolyte gastrointestinal lavage solution. This product is contraindicated in patients with gastrointestinal obstruction, gastric retention, bowel perforation, toxic colitis, or megacolon. On the day prior to the examination, a clear liquid diet should start at lunchtime. Clear liquids include black tea or coffee, broth or bouillon, plain jello, strained fruit juice, popsicles, water, carbonated beverages or sherbet. The patient should not drink milk or cream. At 3 PM on the day before the examination, the patient should start drinking the product GoLYTELY® at a rate of 8 oz (240 mL) every 10 minutes until a total of 4 L has been consumed. Rapid drinking of each portion should be encouraged (as opposed to drinking sips continuously). It is important that each patient drink the entire volume of GoLYTELY® for an adequate GI examination. An alternative method of bowel cleansing may be required in patients with fluid restrictions, with renal failure, with congestive cardiac failure, or in patients younger than 18 years of age. The patient's primary physician should be consulted with regard to this. Orally administered GoLYTELY® induces a diarrhea which rapidly cleanses the bowel, usually within 4 hours. The material is available in a powdered form for oral administration as a solution following reconstitution. Other bowel cleansing preparations are available. See reference.

Aftercare Correct aftercare of the barium enema patient is essential if examination is to be followed by a GI series. If colon is not cleansed of residual barium following barium enema, patient will not be accepted for GI series on the following morning. The following is advised. All patients on return from barium enema examination should be given 10 oz of magnesium citrate at 4 PM. On the following morning, patient should have a Fleet® enema before being sent for GI series.

Special Instructions By appointment only. When a series of gastrointestinal examinations are desired, the procedures should be scheduled as follows.

First day: Gallbladder series: If it is known that the patient is to have a barium enema following the gallbladder series, then preparation for the barium enema should begin on the same day as preparation for the gallbladder series. See Oral Cholecystogram, Gallbladder Series.

Second day: Barium enema followed by adequate aftercare, consisting of 10 oz of magnesium citrate at 4 PM and a Fleet® enema on the following morning, if there is to be a GI series on the following morning. If this is not done, residual barium may remain in the colon so that a GI series is not possible on the following morning.

Third day: Gastrointestinal series and small bowel series. Barium enema will be supplemented by an air contrast study at the discretion of the radiologist. There is no need for the requisition to state "air contrast study". The decision whether to do an air contrast study will reside with the radiologist. An air contrast study may also be done after routine barium enema by consultation with the radiologist. Pyelograms should be scheduled before barium studies of the GI tract.

Causes for Rejection Barium in colon or inadequate preparation

Limitations If a rectal biopsy has been done, barium enema should not be ordered for 10 days. Exceptions to this will be permitted only after consultation with the surgeon involved. Hypotonic colon examination using glucagon will be ordered at the discretion of the radiologist or by consultation with the radiologist. If the patient is to have ultrasonography or computerized tomography, then barium enema should be delayed until these exams are completed. Barium in the abdomen will interfere with these exams. Air contrast examination is not optimally performed following sigmoidoscopy.

References