Double-contrast Barium Enema Examination Research Articles

Compensation filtration in paediatric double contrast barium enema examinations

A prospective study of double contrast barium enema examinations performed on 42 children aged 2.5-19 years (mean age 12.3 years) showed that compensation filtration improved the radiographic quality in 32 (76%) of the examinations; it also reduced radiation dosage in all patients. In no examination was the use of a filter deleterious. Compensation filtration is recommended for all paediatric double contrast barium enema examinations to improve radiographic quality and reduce radiation dosage.

Feasibility of double-contrast barium enema in the elderly

In order to evaluate the feasibility of performing double-contrast barium enemas in the elderly, a consecutive series of 310 patients above 60 years of age referred for barium enema examinations was analyzed relative to the rate of successful studies. There was an overall success rate of 94.8%. There was a 99% success rate in patients in the seventh decade, 94.9% in the eighth decade, and a 90% success rate in patients 80 years and over. A conclusion is reached that the double-contrast barium enema examination is feasible in the elderly.

Early rectal tube removal for improved patient tolerance during double-contrast barium enema examination.

During a five year period, 62 patients each underwent two barium enema examinations. The length of time that the rectal tube remained in place varied in each subject. Early rectal-tube removal resulted in better patient acceptance of the double-contrast barium enema examination.

Bacteremia during double-contrast barium enema examination.

Forty-five patients undergoing double-contrast barium enema examinations were studied to identify the incidence of transient bacteremia associated with the examination. Blood cultures were obtained immediately prior to the examination and at 5, 10, and 20 minutes after the start of the examination. Blood samples were cultured in both aerobic and anaerobic media, and four of these cultures were positive for organisms that are common skin contaminants. No bacteremia was identified from enteric pathogens. The data herein suggest that patients with cardiac valvular disease are not at greater risk of bacteremia during double-contrast barium enema examinations.

Coiled-spring sign of appendiceal intussusception.

Appendiceal intussusception has been considered a rare entity that is difficult to diagnose radiographically. However, a characteristic coiled-spring appearance in the cecum with nonfilling of the appendix has been observed on double-contrast barium enema (DCE) examinations in 11 cases of apparent or proved appendiceal intussusception. In two surgically proved cases, the intussusception was precipitated by an appendiceal mucocele and by endometriosis implants in the appendix. In four other cases, the intussusception was transient and the coiled-spring defect in the cecum disappeared with filling of the appendix on the DCE examination (three cases) or on a subsequent barium enema study (one case). The remaining five cases were unproved, although two patients had undergone prior appendectomy and the coiled-spring finding presumably resulted from an intussuscepted appendiceal stump. Only one patient was found to have appendiceal-related symptoms. It appears that appendiceal intussusception often occurs as a transient phenomenon in asymptomatic patients, and that it can be diagnosed on the routine DCE examination by a characteristic coiled-spring defect in the cecum.

Compensation Filtration for Decubitus Radiography During Double-Contrast Barium Enema Examinations

Feczko, Peter J. MD; Haggar, Allan M. MD; Rauch, Phillip L. MD; Halpert, Robert D. MD, and; Simms, Stuart M. MD

Radiological features of familial polyposis coli: grouping by polyp profusion.

The radiological features of familial polyposis coli (FPC) were studied in 60 patients by double-contrast barium enema examinations. When classified by profusion of polyps, cases fell into two groups: the profuse type and the sparse type. The radiologically determined boundary range distinguishing these types was 6-9 polyps/cm2 in adult patients and 3-6 in children. But on grouping the FPC patients by size of the polyps, one group of 34 cases had one or more polyps of more than 1 cm diameter, and in 16 of this group, one or more advanced cancers were histologically demonstrated; whereas in the group of 20 patients, in which the lesions were 5 mm or less, no malignancy was detected. In contrast to cases of the sparse type, in which the size of the polyps bore no relation to age, all cases of the profuse type who were 15 years old or more had polyps more than 1 cm in diameter.

Combinations of laxatives for bowel preparation: Are they necessary?

To determine whether combinations of saline and surface-acting laxatives have any superior action over saline laxatives alone in cleansing the colon, patients having double-contrast barium enema examinations were randomly allocated to magnesium citrate alone and magnesium citrate with either oral or rectal bisacodyl. The addition of bisacodyl conferred no benefit over magnesium citrate alone. A companion study of magnesium citrate and sodium picosulphate (Picolax) showed no benefit over magnesium citrate alone. It is concluded that it is unnecessary to add a contact or surface-acting laxative to 25 g of magnesium citrate for bowel preparation.

Compensation filtration for decubitus radiography during double-contrast barium enema examinations.

Lateral decubitus images obtained during double-contrast barium enema examinations may be difficult to interpret because of the large difference in density between the various parts of the radiographs. Several types of filters are described which can be used to rectify this problem, thus improving the quality of the decubitus radiographs and achieving a slight reduction in radiation exposure.

Postendoscopy barium enema examinations.

A study was designed to evaluate whether sigmoidoscopy performed on the same day as barium enema examination interferes with quality or interpretation of the barium study. The study included 295 patients who had either single- or double-contrast barium enema examinations subsequent to sigmoidoscopy performed either on a prior day or the same day. Luminal air, spasm, colonic fluid, and mucosal coating were assessed, as was the resultant diagnostic quality of each barium examination. The results suggest that rigid or fiberoptic sigmoidoscopy can be performed the same day as single- or double-contrast barium enema examinations without adversely affecting the quality or interpretation of the barium study.

Rectal Injury During Barium Enema Examination

To the Editor.— In TOPICS IN RADIOLOGY (1982;248:1375), Walker and colleagues describe massive extravasation of extraperitoneal air in an elderly woman after double-contrast barium enema (DCBE) examination. Although the authors note a low reported incidence (0.02%) of rectal injury from DCBE examination and allude to wide variations in quantities of extraperitoneal and intraperitoneal air that may accumulate, they conspicuously underemphasize the potential lethality of this complication. Because these patients have fortuitously been thoroughly cleansed of stool by preexamination enemas and laxatives, such injuries may be treated expectantly. Nevertheless, as the following case report exemplifies, rectal tear from DCBE examination endangers life and may require prompt aggressive treatment. Report of a Case.— A 51-year-old asymptomatic woman underwent DCBE examination for follow-up of a benign polyp removed from the sigmoid colon three years earlier. Toward the end of the examination, the retention balloon suddenly ruptured, expelling the catheter. Although no immediate discomfort

Rectal Injury During Barium Enema Examination-Reply

In Reply.— We thank Dr Nathan for furthering our knowledge of the complications of the double-contrast barium enema (DCBE) examination with his case report, which seems to be unique in the literature. A contained intramural perforation that later showed extravasation of barium has been reported with the single-contrast barium enema (BE) examination. 1 Dr Nathan raises two questions that cannot yet be answered definitively: (1) How common are rectal perforations during DCBE examination? (2) What treatment is required? In regard to the first question, there are as yet too few published data to determine the risk of rectal perforation during DCBE examination relative to the better-defined risk during the BE examination. Indeed, the two-in-10,000 figure we cited in our article is the only one available in the English-language literature. In comparison, the frequency of rectal perforation during conventional BE examination was six in 20,000 (ie, one in 3,333) in the largest

The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding.

We examined 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum, or hematochezia to determine the value of the double-contrast barium-enema (DC-BE) examination and colonoscopy/proctoscopy in establishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the two examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and seven of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only eight additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures, and anal tears, and seven of these were found in patients who were older than 50 years of age. We conclude that colonoscopy is superior to the DC-BE examination in the detection of bleeding sites but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 years old or older.

Optimum overhead views in double-contrast barium-enema examinations.

On 100 consecutive double-contrast barium-enema examinations demonstrating a benign or malignant mass in the colon, 10 overhead views were analyzed to determine the smallest number of projections that would permit an accurate diagnosis. The combination of six overhead views (anteroposterior, posteroanterior, angled view of the rectosigmoid, lateral view of the rectum, right and left decubitus) and fluoroscopic spot films of the cecum, transverse colon, and flexures was sufficient to demonstrate all colonic masses. In no instance was a lesion seen only on overhead views performed with the patient in an oblique position. Elimination of the four oblique views from the routine double-contrast barium-enema examination can result in substantial savings in cost and radiation exposure without adversely affecting diagnostic accuracy.

Work in progress. The anal canal: distinction of internal hemorrhoids from small cancers by double-contrast barium enema examination.

Sixty-six patients with normal anal canals, 66 patients with internal hemorrhoids, and 6 patients with small cancers in the anal canal were examined by double-contrast barium enema examination. Internal hemorrhoids appeared as single nodules in 3 patients, multiple nodules in 59 patients, a polypoid mass in 3 patients, and a varicoid mass in 1 patient. Small cancers appeared as slightly irregular polypoid masses in 5 patients and as a plaque-like lesion in 1 patient. The sensitivity for detecting internal hemorrhoids was 83%, the specificity was 88%, and the overall accuracy was 86%. The sensitivity for detecting small cancers in the anal canal was 83% and the specificity was 98%. Internal hemorrhoids and small cancers in the anal canal can be easily detected and distinguished from one another by double-contrast barium enema examination.

Colonoscopy: its role in cancer of the colon and rectum.

In order to determine the feasibility, yield, and impact of routine total colonoscopy on the management of large-bowel cancer, 157 cancer patients underwent 175 colonoscopic procedures; 13.6 per cent of the cancers had been missed on double-contrast barium enema examination. Among 92 patients undergoing perioperative colonoscopy, the lesion was reached in 90 per cent and the cecum in 60 per cent; 7.6 per cent demonstrated synchronous cancers, all curable, and all missed on barium-enema examination. Seventy-eight patients underwent colonoscopy at an average of 3.7 years after treatment of the index cancer; 7.7 per cent demonstrated metachronous cancers, all curable, two-thirds of which were missed on barium-enema examination. Benign polyps were noted in 62 per cent of the patients studied; 77 per cent of those polyps, 1 cm or greater in size, were missed on barium-enema examination. Polyps were found proximal to the cancer in 60 per cent of the patients with polyps. Approximately 85 per cent of those with multiple cancers demonstrated benign polyps. Preoperative total colonoscopy with periodic postoperative colonoscopy at an interval of three to five years are essential in the reliable detection of synchronous cancers and for the detection of metachronous cancers at an earlier, more favorable stage.

Diagnosis and treatment of retroperitoneal perforation complicating the double-contrast barium-enema examination.

A case of retroperitoneal air caused by rectal perforation during a double-contrast barium-enema examination is reported. In 9 similar reported cases, radiographic signs included perirectal, mediastinal, and cervical emphysema. Because of the frequent absence of clinical signs, radiographic recognition may be crucial for prompt management. Reported experience suggests that asymptomatic patients with these radiographic findings may be managed with hospitalization and close observation rather than immediate laparotomy.

Routine use of hyoscine N butylbromide (buscopan) in double contrast barium enema examinations

A retrospective analysis of the effect of oral and intravenous hyoscine N butylbromide (Buscopan) on the dimensions of the large bowel during double contrast barium enema (DCBE) examination was made and compared with corresponding measurements without Buscopan. It was found that 20 mg oral Buscopan did not alter colonic dimensions but 20 mg Buscopan intravenously allowed significantly greater distension of the large bowel. The colonic length was greater after intravenous Buscopan but not to a highly significant degree. It is concluded that Buscopan is not effective when given orally. No side effects have been observed with intravenous Buscopan, even in elderly patients. Buscopan given intravenously seems to be a safe and effective drug for use during DCBE examinations.

The barium enema diagnosis of paracolic abscess

The barium enema diagnosis of 38 cases of paracolic abscess is discussed. The importance of an appreciation of the anatomy of the peritoneum and of the paracolic region is emphasized. Five features of paracolic abscess that can be recognised on double contrast barium enema examination are analysed. These are soft tissue mass; extraluminal gas collection; barium-filled cavitation; displacement, impression or narrowing of the lumen; and mucosal changes. The commonest feature, present in 95% of cases, is displacement or impression or narrowing of the bowel lumen. An analysis according to site and aetiology is presented and the commonest causes found to be diverticulitis and appendicitis. The differential diagnosis is discussed, and differentiation from primary colonic carcinoma, metastases, Crohn's disease, ischaemia and endometriosis is described.

Radiology in investigation of rectal bleeding.

Although most causes of chronic anorectal bleeding are diagnosed from clinical or sigmoidoscopic examination, there are a number of conditions not detectable from barium enema studies. Results of colonoscopy are compared to those for single- and double-contrast barium enema examinations, and recommendations are made for increasing diagnostic accuracy.