Choose the technique you wish to review:

• Patients without ileostomies

• Patients with ileostomies

For Patients with Mucosal, Mural or Mesenteric Disease:

This technique is used for mucosal and for mural and mesenteric disease.

This technique provides a two phase evaluation of the small bowel.

1. Single contrast
2. Double contrast phase (rectal insufflation of air or carbon dioxide)
3. Fluoroscopic and Compression evaluation

Technique:

• Equipment:
  • 800 cc of Dilute barium (33% w/v) (Use Ultra R barium)
  • Air or carbon dioxide (infused via a cleansed colon)
  • Use small Foley rectal catheter for insufflation
  • May use antispasmodic to get adequate reflux into small bowel.
     
• Images:
  • Images of the entire small bowel are taken in single phase
    • Overhead survey views
      • Views are taken every 15 minutes until barium reaches right colon
      • All views are checked and spot views taken if abnormality found
         
  • The colon is insufflated with air or carbon dioxide to obtain reflux of air into distal ileum
    • Spot views of the different areas of the small bowel, especially the terminal ileum are taken.
    • Compression of ALL parts the small bowel is mandatory

Disadvantages:

• Requires colon cleansing for an adequate study
• Uncomfortable procedure for the patient.
• Reflux sometimes not possible (competent ileo-cecal valve)
• Long procedure times

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For Patients with Ileostomies and Mucosal, Mural or Mesenteric Disease:

This technique is used for mucosal and for mural and mesenteric disease, in patients with ileostomy.

This technique provides a two phase evaluation of the small bowel.

1. Single contrast
2. Double contrast phase
3. Fluoroscopic and distention evaluation

Technique:

• Equipment:
  • 800 cc of Dilute barium (33% w/v) (Use Ultra R barium)
  • Air
  • Use small Foley catheter for insufflation through the stomal opening
  • May use antispasmodic to get adequate reflux into small bowel.
     
• Images:
  • Images of the entire small bowel are taken in single phase
    • Overhead survey views
      • Views are taken every 15 minutes until barium reaches right colon
      • All views are checked and spot views taken if abnormality found
         
  • The stoma is intubated and air is insufflated in a retrograde fashion
    • Spot views of the different areas of the small bowel, especially the terminal ileum are taken.
    • Compression of ALL parts the small bowel is mandatory

Disadvantages:

• Uncomfortable procedure for the patient.
• Long procedure times

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References:

Zalev AH.  Peroral Peumoileum in patients with ileostomy.  Canadian Association of Radiologists Journal. 1994;45(3):204-208