The Peroral Pneumocolon Examination

Technique and Indications1

Herbert Y. Knessel, M.D. TABLE I: Indications for a Peroral Pneumocolon Examination

Kathryn A. Evens, M.D.2 -Poor visualization of the terminal ileum on small-bowel follow-through examination (e.g.,
Seth N. Gbick, M.D.3 low-lying pelvic cecum or pelvic adhesions)

Igon Laufer, M.D. -Poor visualization of the right colon or prior barium enema examination (e.g. , poor coating
Hans Henbingen, M.D. or residual colonic debris)
-Re-evaluation of a suspicious region noted on a barium enema or small-bowel follow-through
The peroral pneumocolon examination is examination
a method for obtaining a double-contrast
image of the terminal ileum and right -Suspected inflammatory bowel disease
colon by insufflating air through a small
-Ileocolic anastomoses
catheter inserted into the rectum when
orally ingested barium reaches the right -Patient unable to retain barium for a barium enema examination
colon. The examination is indicated if a
detailed view of the ileocecal region is
required, particularly when inflammatory
bowel disease is suspected, when polyps usually posteromedial, insufflation with
Materials and Methods
are present in the right colon, or when the patient prone promotes neflux of gas
patients are unable to tolerate barium The examination is usually performed
into the terminal ileum.
enema studies. as part of an upper gastrointestinal series
Once adequate distension of the ibeo-
with a sn’iall-bowel follow-through
cecal region is achieved, spot views of the
Index terms: (Colon. air contrast exam, evaluation. In some patients, the results
7(5)1282) Colon,
#{149} radiography (Cl
#{149} system.
area are obtained with the patient prone,
of a prior barium enema examination supine, and in the right and left posterior
enteritis or colitis, 7[0].260)
may suggest the need for further study of
oblique positions. Right and left lateral
the ileocecal region; the colon is then decubitus views may be valuable in se-
prepared as if a barium enema examina- lected cases.
Radiology 144: 414-416. July 1982
tion is to be performed. In other patients,
indications for a peroral pneumocobon
examination may become apparent dun- Discussion

T HE PERORAL PNEUMOCOLON exami-

ing the
follow-through
course of the
evaluation
routine
.
small-bowel
No prepara-
The peroral
is indicated
pneumocolon
whenever a detailed
examination
study of
nation is a method for obtaining a
tion other than the overnight fast is pos- the ileocecal region is required (TABLE I).
double-contrast examination of the ileo-
sible; surprisingly, excellent coating is This includes cases in which the barium
cecab area and right colon with orally
achieved and right colon detail is visu- enema study is inadequate and poor
administered barium. Although this
alized. coating of the right colon precludes a
technique has been described in radio- The patients are given a well-sus- definite diagnosis of a suspected or
logic literature (1-3), its application has
pended, low-density (40% W/V) barium poorly defined abnormality (Fig. 1). The
not become widespread. We perform the
preparation (480 ml) orally.4 This may be examination may also be indicated
peroral pneumocobon examination rou-
in addition to the high-density (240% whenever a detailed study of the cecum
tinely to obtain a detailed double-contrast
W/V) barium suspension (150 ml) given and terminal ileum is required and the
view of the ibeocecal region.
initially for a double-contrast examina- ileum is poorly visualized on the small-
tion of the stomach and duodenum. Ab- bowel follow-through evaluation (Fig. 2).
dominal radiographs with the patient In many patients, the perorab pneumo-
I From the Department of Radiology. Hospital
supine are obtained at 15-30-minute in- colon examination may obviate the need
of the University of Pennsylvania, Philadelphia.
tervabs until the barium column is shown for a repeat barium enema or small-bowel
Presented at the Sixty-fifth Scientific Assembly
and Annual Meeting of the Radiological Society
at the hepatic flexure of the colon. study and thus reduce medical costs and
of North America, Atlanta, Ga., Nov. 25-30, 1979. A soft rubber catheter is inserted into time of hospitalization for the patient.
(Address reprint requests to H.Y.K., Dept. of Ra- the rectum. Glucagon (0.5-1.0 mg) is ad- The examination can also serve as a pri-
diology, Hospital of the University of Pennsyl- ministered intravenously in order to me- mary evaluation of the entire right colon
vania, 3400 Spruce St.. Philadelphia PA 19104.) duce patient discomfort during air in- in elderly patients unable to retain
Received June 10, 1981; accepted July 21; revision
sufflation and to establish intestinal hy- enough barium for a barium enema
received Mar. 8, 1982. sb
2 Present location: Department of Radiology, potonia. In addition, the use of glucagon study.
University of Massachusetts Medical Center, may facilitate reflux through the ileocecal
Worcester, Mass. valve (4). Air insufflation begins with the
3 Present location: Department of Radiology, patient prone. The patient is then turned
Conclusion
Hahnemann Medical College. Philadelphia, Pa.
to the right lateral, supine, left lateral, The double-contrast study with orally
4 Both Barotrast (Barnes-Hind Pharmaceuticals,
and finally to the prone position again to ingested barium is a simple, reliable, and
Inc., 895 Kifer Rd., Sunnyvale CA 94086) and
Sol-O-Pake (E-Z-EM Co., Inc., 7 Portland Ave., allow for uniform distribution of gas and effective method for obtaining a detailed
Westbury NY 1 1590) have been used success- prevent focal overdistension and patient image of the ileocecal region. The mini-
fully. discomfort. As the ileocecal valve is mab preparation and ease of performance

414 July 1982 Volume 144, Number 2

A 68-year-old woman was admitted for evaluation of malaise, anemia, and hematochezia.
a. A double-contrast barium enema examination revealed a single protrusion in the cecum (arrow); however, coating is suboptimal and the
relationship of the protrusion to the ileocecal valve is not certain.
b. A peroral pneumocolon examination reveals four additional polypoid lesions in the cecum (arrows).

Figure 2

a. b.
A 30-year-old man had a history of right lower quadrant pain, fever to 101 0 F (38.3#{176} C), and leukocytosis.
a. A small-bowel follow-through examination reveals thickening and straightening of the folds in the right lower quadrant as well as evidence
of a mesenteric mass effect. Arrows identify the cecum and right colon.
b. A peroral pneumocolon examination reveals aphthoid ulceration (arrows), characteristic of Crohn disease, in the distal ileum.
should allow routine peroral pneumo- pneumocobon examination may obviate of the cecum and proximal ascending colon with
colon examinations. Insufflation of air the need for repeated barium studies if ingested barium. Radiology 1961; 76:415-421.
2. Kellet MJ, Zboralske FF, Margulis AR. Per oral
with the patient in the prone position the initial results are equivocal.
pneumocolon examination of the ileocecal re-
facilitates reflux into the distal ibeum. gion. Gastrointest Radiol 1977; 1:361-365:
Contraindications would be limited to 3. Pochaczevsky R. Oral examination of the colon:
patients with suspected colon obstruction “the colonic cocktail.” AJR 1974; 121 :318-325.
4. Violon D, Steppe R, Potvliege R. Improved
where barium could accumulate proximal References
retrograde ileography with glucagon. AJR 1981;
to the obstructing lesion. The peroral 1. Heitzman ER, Berne AS. Roentgen examination 136:833-834.

416 July 1982 Volume 144, Number 2