Plain abdominal radiograph and barium enema

A barium enema (Figures 3.1 and 3.2) is the gold standard for demonstrating the severity of colonic diverticular disease (Halligan and Saunders, 2002). The radiograph involves the radio-opaque substance barium being inserted into the colon as an enema. There are two different barium enemas: a single contrast where barium alone is used; and barium and air as a double-contrast barium enema.

The patient has to have his or her bowel cleansed and all radiology departments have their own method of achieving a cleansed bowel. Essentially, the patient will take the bowel cleansing agents 24-48 hours before the examination; there may also be an element of a low-residue diet

Barium Enema Diverticular Disease

Figure 3.1 Barium enema: progress of barium through the colon, showing diverticular disease. (Courtesy of C. Bateman.)

Figure 3.1 Barium enema: progress of barium through the colon, showing diverticular disease. (Courtesy of C. Bateman.)

included, with only clear fluids being allowed after the bowel cleansing agent has been taken. To achieve perfect views of the colon, there needs to be an absence of faecal matter.

Pancreatic Cancer Barium Enema
Figure 3.2 Contrast barium enemas: radiographs. (Courtesy of C. Bateman.)

In both examinations, once the barium has been inserted the patient needs to move around at the direction of the radiographer, in order to coat the wall of the bowel from the rectum to the caecal valve. It is important for the examination that the patient is able to hold on to the barium to maximize optimum pictures. A weak rectal sphincter will not allow this to happen. For elderly people this examination may not be pleasant because of holding on to the barium and the amount of turning that is required. The barium is a good medium for showing a bowel diverticulum. A barium enema does not allow for biopsies or removal of polyps. During the examination, if a biopsy or polypectomy is required, the patient needs to be referred to the endoscopy unit for further investigations. Unfortunately this requires more bowel preparation. It is possible to go from endoscopy to radiology but not the other way round, because of the barium.

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