Low temperature barium-water suspensions for roentgenologic examination of the colon.

Abstract

It has long been common practice to administer barium enemas at “comfortable body temperature.” Hot or cold water is added until the suspension is “comfortably warm” on the more sensitive skin of the volar aspect of the forearm, the temperature usually varying from 100 to 110° F. For a number of years it has been our practice to use water at 41 ° F. In our geographic climate this is obtained from the cold water faucet in winter and at other times the water is chilled to this temperature. After use in several thousand cases, this method has proved to possess certain advantages. One of the difficulties frequently encountered in examining the colon by enema is the inability of the patient to retain the barium suspension. It is common practice, therefore, to insert a balloon into the rectum and inflate it so that the lumen is occluded. Since the balloon completely obscures the rectum, and since 30 per cent of all gastrointestinal cancers occur in this portion of the bowel (1), it is obvious that such a practice definitely militates against detection of a most serious possible lesion. It is well known that hyperemia of the colon produces irritability. Such irritability is seen in inflammatory lesions of the colon, ulcerative colitis, tuberculosis of the cecum (Stierlin's sign), and chemical or drug irritation. Water at a temperature of 110° F. may be comfortable to the skin on the forearm, but in the colon it produces active hyperemia. While the colon itself lacks thermal sensitivity, it responds to the effect of heat transmitted through its wall to the blood vessels which penetrate it. Cold, on the other hand, results in local ischemia, and, depending on the temperature and its duration, produces a variable degree of anesthesia in any body area with which it is in contact. A cold suspension of barium sulfate is therefore conducive to more complete and more comfortable retention in the colon. It has been shown that “application of warmth to the region of the anus causes reflex relaxation of the (anal) sphincter; application of cold increases its tonic contraction.” The contracted anal sphincters assist the patient in retaining the enema. Moreover, according to the law of reciprocal innervation, “stimuli in the colon or rectum which give rise to a defecation reflex cause a reciprocal contraction of the lower bowel and relaxation of the anal sphincters. Conversely, stimulation (contraction) of the anal canal leads to reflex dilatation of the bowel” (2). By virtue of this physiologic mechanism cold suspensions of barium are more easily instilled into the relaxed colon and are more easily retained with the help of the contracted sphincters. Double-contrast examination of the colon is usually employed for the detection of polyps. Air has always been used as the second contrast medium (3, 4), although compressed carbon dioxide has been shown to be far superior for the purpose (5, 6).