Barium Follow-through TBL

7/31/2019 Barium Follow-through TBL

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Barium follow-through

Used to evaluate the small intestine

Contrast medium appears white on x-

rays,showing internal lining of the bowel

X-ray images taken as the contrast moves

through the intestine, commonly at 0 minutes,

20 minutes, 40 minutes and 90 minutes

Test completed when barium is visualized in

the terminal ileum and Caecum


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Clinical Application

Long segment narrowing of the jejunal loops with loss of mucosal pattern

and bowel wall thickening.Diagnosis:Crohns disease


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Overhead image from a small bowel follow through in a

patient with history of Crohn's disease demonstrates

evidence of terminal ileal wall thickening, causing

narrowing of the lumen.

Frontal spot image from SBFT showssmooth elongated mass (black arrows) in

distal ileum with telescoping of small bowel

(intussusceptum, white arrow) into

adjacent lumen (intussuscipiens), producing

coil spring appearance (arrowheads). This

patient had inverted Meckel diverticulumactin as lead oint for intussusce tion.


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49-year-old woman with Crohn's disease involving small bowel. Five years

before these imaging studies were obtained, patient had undergone

segmental resection of ileum because of protein-losing enteropathy. Spot

compression image of small-bowel follow-through study obtained 1 day

afterA shows linear ulcer (arrows) in mesenteric border and

pseudosacculation (arrowheads) along antimesenteric border.


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Frontal spot image from SBFT shows primary adenocarcinoma

of small bowel as annular lesion in jejunum, with

circumferential narrowing, shelflike margins (black arrows),

and small central ulcer (white arrow).


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Contraindications

- known or suspected obstruction of the colon

- suspected tracheoesophageal fistula,

- known obstructing lesions of the small intestine,

- pyloric stenosis

- known hypersensitivity to barium sulfate formulations.- Imminent surgery and or suspected perforation; require water soluble

contrast media.

Adverse effects

aspiration pneumonitis

barium sulfate impaction

granuloma formation

intravasation, embolization and peritonitis following intestinal perforation

vasovagal and syncopal episodes

allergic reactions in atopic patients


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Small bowel enema(Enteroclysis)

Alternative for small bowel examination

A thin tube/catheter is passed down the

oesophagus, through the stomach, and into

the first part of the small intestine.

Barium liquid is then poured down the tube

Demonstrates strictures or adhesions whenthere is suspicion of intermittent obstruction


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Frontal spot image from enteroclysis shows normal

folds in distal jejunum as thin (12-mm-thick)

delicate structures perpendicular to longitudinal axis

of bowel. There are normally four to seven folds per

inch of jejunum.


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Frontal spot image from enteroclysis shows multiple smooth-

surfaced hemispheric submucosal masses (white arrows) in small

bowel; other lesions have bull's-eye appearance (black arrows)

due to central ulceration. This patient had malignant melanoma

with hematogenous metastases to small bowel


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Left posterior oblique spot image from enteroclysis shows

partially obstructing adhesive band as vertically oriented,

extrinsic, bandlike impression (arrows) traversing lumen of

jejunum, with proximal dilatation.


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Barium Enema

To examine and diagnose problems with thecolon(large intestine)

Patient lies on the X-ray table and a preliminary X-ray istaken

A well lubricated enema tube is inserted intothe rectum

Barium sulfate and air/Co2 is then allowed to flow intothe colon

A small balloon at the tip of the enema tube may beinflated to help keep the barium sulfate inside

flow of the barium sulfate is monitored by the healthcare provider on an X-ray fluoroscope screen


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Frontal spot image from double-contrast barium

enema examination (with reflux into terminal

ileum) shows carcinoid tumor as smooth, sessile,

1.5-cm-diameter polyp (black arrows) in terminal

ileum. Also note multiple ileal diverticula (whitearrows).

18-year-old woman with Crohn's

disease involving colon. Image

from double-contrast bariumenema reveals longitudinal and

perpendicular ulcerations

(arrows) in right colon.


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Peripheral T-cell lymphoma of the colon with diffuse

involvement in a 42-year-old woman.Double-contrast barium

enema image shows multiple shallow (arrows) and aphthous(arrowheads) ulcerations in the entire colon.

Small ulcerations with a

diffuse distribution

(arrows) and geographic

ulceration (arrowhead)


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Contraindication

Adverse effects


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Barium Swallow Barium Meal Barium Follow-

Through

Barium Enema

Indications Dysphagia,Heartburn,

Chest pain,Motility

disorder

Dyspepsia,Epigastric

pain,Anaemia,Vomiting

,Perforation(non-ionic

contrast)

Diarrhoea& abdominal

pain of small bowel

origin,possible

obstruction by

strictures

Altered bowel

habit,rectal

bleeding,Anaemia

Major Uses Strictures,Hiatus

hernia,GERD,motility

disorders(e.g:achalasia)

Gastric/duodenal

ulcer,gastric ca/outlet

obstruction,gastric

emptying disorders

Malabsoprtion,Crohns

disease

Neoplasia,Diverticulosi

s,strictures(e.g:ischaem

ic),megacolon

Limitations Risk of aspiration,poor

mucosal detail,unable

to biopsy

Low sensitivity for early

ca,Unable to biopsy or

assess

Helicobacter pylori

Time-

consuming,radiation

exposure

Difficult in frail elderly

or incontinent

patients,uncomfortable

,sigmoidoscopy

necessary to evaluaterectum,Misses

polyps

Documents

Barium Follow-through TBL