A barium enema, also called a lower gastrointestinal series, is a medical procedure used to examine and diagnose problems with the human large intestines. An X-ray examination of the large intestines, pictures are taken after rectal instillation of barium sulfate.

How the test is performed
This test may be done in a hospital or clinic radiology department. The patient lies on the X-ray table and a preliminary X-ray is taken. The patient is then asked to lie on the side while a well lubricated enema tube is inserted gently into the rectum. The barium, a radiopaque (shows up on X-ray) contrast medium, is then allowed to flow into the colon. A small balloon at the tip of the enema tube may be inflated to help keep the barium inside. The flow of the barium is monitored by the health care provider on an X-ray fluoroscope screen (like a TV monitor). Air may be puffed into the colon to distend it and provide better images.

The patient is usually asked to move to different positions and the table is slightly tipped to get different views.

If a double or air - contrast examination is being done, the enema tube will be reinserted gently and a small amount of air will be gently introduced into the colon, and more X-ray pictures are taken.

If there is a suspected bowel perforation, water-soluble contrast is used instead of barium. The study is otherwise very similar, although the images are not quite as good. (The concern with existing perforation is that contrast will leak from the bowel to the peritoneal cavity, and water-soluble material is less irritating than barium.)

Preparation
Thorough cleaning of the large intestine is necessary for accurate pictures. Test preparations include a clear liquid diet, drinking a bottle of magnesium citrate (a laxative), and warm water enemas to clear out any stool particles.

Why the test is performed
The test is used to detect colon cancer. The barium enema may also be used to diagnose and evaluate the extent of inflammatory bowel diseases such as Crohn's disease.

Barium study is usually used to diagnosis disease. However, in certain cases, barium enema is used to treat intussusception.

Normal Values
Barium should fill the colon uniformly and show normal bowel contour, patency (should be freely open), and position.

What abnormal results mean
Abnormal findings may include cancer, diverticulitis (small pouches formed on the colon wall that can become inflamed), polyps (a tumor, usually noncancerous, that grows on the mucous membrane), inflammation of the inner lining of the intestine (ulcerative colitis), and irritable colon. An acute appendicitis or twisted loop of the bowel may also be seen.

Additional conditions under which the test may be performed:

annular pancreas
CMV gastroenteritis/colitis
colorectal polyps
Hirschsprung's disease
intestinal obstruction
intussusception (children)
pyloric stenosis

What the risks are
There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of the X-ray.

A more serious risk is a bowel perforation, which is very rare.

Special considerations
CT scans and ultrasounds are now the tests of choice for the initial evaluation of abdominal masses.
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