SPECIALISED IMAGING TECHNIQUE

( RXD 23503 )

SMALL BOWEL ENEMA

MUHAMMAD RIFQI BIN ABDUL RAHMAN

MEDICAL IMAGING PROGRAMME
FACULTY OF FPHS

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 LEARNING OUTCOMES

The end of the topic, students should be able to:

1. Understand the definition, indications and contraindications of Small Bowel Enema

examination.

2. Describe the patient’s preparations; Radiographer‘s responsibilities; patient’s care

before, during and after the Small Bowel Enema examination.

3. State the advantages and disadvantages of this technique.

4. Explain the techniques of Small Bowel Enema examination.

 SMALL BOWEL ENEMA

• This is a procedure to examine the small bowel which coat with barium. A soft
plastic tube is passed in through the nose & down the esophagus into the small
bowel.
 PATIENT PREPARATION

1) A low residue diet for 2 days prior to the examination.The Radiographer /

Staff Nurse will explain what to eat and drink on the day before and the
day of the appointment.

2) To view the small bowel clearly without any faeces and air, patient will be given
laxatives called Dulcolax during appointment but it depend to patient’s
pathology.
 PATIENT PREPARATION
3) Patient must fasting about 8 hours before the examination.

4) Radiographer must check last menstrual period for female patient to make
sure patient not pregnant.

5) Radiographer must make sure previous radiographs and Radiologist report

from other examinations are available.
 PATIENT PREPARATION

6) Make sure patient’s identification are correct such as name and

registration number.

7) The physician will explain the procedure to the patient / family

members regarding the technique and risks.

8) Patient / family member already signed a consent form that

gives permission to do the procedure.
 PATIENT PREPARATION

9) Make sure patient had no allergy to contrast medium, medications

and foods.

10) Patient will be asked to remove any jewelry, hairpins, dentures

or other objects that may interfere with the procedure & wear
hospital gown.
INDICATIONS & CONTRAINDICATIONS

Same as for a barium follow through examination.

PRELIMINARY

• Plain AXR
 TECHNIQUE
1) Patient sits on the edge of the fluoroscopy table.

2) Immediately before the examination the pharynx is anaesthetized with

lignocaine spray to allow a smooth & more comfortable passage of the tube.
 TECHNIQUE

3) The lignocaine spray may taste unpleasant

for a short while, but is intended to help the
passage of a long thin tube into the nose and
down through to the stomach.

4) The tube is then passed through the nose /

the mouth.
 TECHNIQUE (contd)
5) The patient is asked to swallow
as the tube is passed through
the pharynx.

6) The tube is then advanced into

the gastric antrum.

7) The patient then lies down &

the tube is passed into the
duodenum.
 TECHNIQUE
Various techniques may be used to help this part of the procedure:

1. Patient lie on the Left side so that the gastric air bubble rises to the antrum, thus
straightening out the stomach.

2. Advance the tube while applying clockwise rotational motion (as viewed from the head of
the patient looking towards the feet).

3. Patient in sitting position to overcome the tendency of the tube to coil in the fundus of the
stomach.
 TECHNIQUE (contd)

8) Applying clockwise rotational may

help in getting past the junction
of the 1st & 2nd parts of the
duodenum.
 TECHNIQUE

9) Barium is administered through the tube.

10) The radiologist observes the flow of barium through the small bowel via fluoroscopy.

11) At various points during the exam, patient will be instructed to move into different

positions such as prone & supine.

12) Patient should hold their breath when spot images are taken to view any abnormalities.

13) The tube is then withdrawn after the examination is complete, when the contrast reach

terminal ileum and caecum, which marks the beginning of the large bowel. .
 AFTERCARE
1) Patient may feel a little nausea, so it is better if someone (relative) accompanies
after the procedure.

2) Patient may continue with their usual diet.

3) The patient should be warned that diarrhea may occur as a result of the large
volume of fluid given.

4) Remind patient their faeces may appear white for a day or two due to contrast
medium.
 COMPLICATIONS
1) Aspiration

2) Perforation of the bowel due to manipulation of the tube.

3) The local anaesthetic applied to the pharynx may cause difficult in swallowing
but this effect only for a few minutes.
 ADVANTAGE

❖Gives better visualization of the small bowel than Barium Follow Through
examination because rapid infusion of a large, continuous column of contrast
medium directly into the small bowel can avoid segmentation of the barium
column & does not allow time for flocculation to occur.
 DISADVANTAGES

1) Intubation may be unpleasant for the patient.

2) It is more time consuming for the Radiologist.

3) There is a higher radiation dose to the patient during screening to monitor

the tube position.
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NORMAL SMALL BOWEL

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NORMAL SMALL BOWEL

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NORMAL SMALL BOWEL

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Question:

• Point out TWO (2) disadvantages of using a soft plastic catheter

during small bowel enema technique.
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