•  A retrograde ileostomy contrast study is done on patients who are scheduled for an ileo-anal pouch procedure to check for Crohns disease or to retrogradely assess the small bowel for recurrence of Crohns or other bowel symptoms such as obstruction.
   
• It is a difficult examination because of the retrograde nature of the instillation of contrast and the anterograde peristaltic movement of the ileum. It is therefore advisable to give a hypotonic agent intravenously such as Glucagon (1 mgm) or Buscopan (10 mgm).

Technique

•  A 14F or 16F Foley catheter and Polibar plus barium (105% w/v) is diluted down to about 30-50% w/v concentration or hypaque 30% (when clinically indicated)
   
• After administering the hypotonic agent, the catheter is inserted into the ileostomy opening, inflating the balloon to prevent reflux of the barium.
   
• About at least ½ the length of the small bowel (minimum of 40 cm) should be filled with barium depending on the history of the patient.
   
• For patients scheduled for an ileo-anal pouch procedure about 1/3 (2-4 feet) of the small bowel opacified is sufficient. The stomal segment of the small bowel (between the catheter and the ileostomy opening) should be imaged at the end of the study.
   
• The stomal position is best examined by placing the patient in an oblique or lateral position to elongate the stoma.
   
• At least one 14 x 14 or 14 x 17 radiograph should be taken to get an overview of the small bowel along with other spot views of the different segments of small bowel.
   
• If technically possible, you can instill air retrogradely to perform a double contrast exam.