Barium enema

Lower gastrointestinal series
Medical diagnostics
ICD-9-CM	87.64
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A lower gastrointestinal series is a medical procedure used to examine and diagnose problems with the human colon (large intestine). Radiographs (X-ray pictures) are taken while barium sulfate, a radiocontrast agent, fills the colon via an enema through the rectum.

The term barium enema usually refers to a lower gastrointestinal series, although enteroclysis (an upper gastrointestinal series) is often called a small bowel barium enema.

This test may be done in a hospital or clinic. 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 into the rectum. As the enema enters the body, the patient might have the sensation that they have to have a bowel movement. The barium sulfate, a radiodense (shows as white on X-ray) contrast medium, is then allowed to flow into the colon. A large balloon at the tip of the enema tube may be inflated to help keep the barium sulfate inside. The flow of the barium sulfate 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 (often called a "double-contrast" exam). If air is used, the enema tube will be reinserted if it had been removed and a small amount of air will be introduced into the colon, and more X-ray pictures are taken.

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

If there is a suspected bowel perforation, a water-soluble contrast agent is used instead of barium. The procedure is otherwise very similar, although the images will be of poorer quality. If a perforation exists, the contrast will leak from the bowel to the peritoneal cavity; water-soluble material is less obscuring compared to barium should an abdominal incision to remove the contrast be necessary.

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