Lower gastrointestinal series

Lower gastrointestinal series
Diagnostics
ICD-9-CM	87.64

A lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon (large intestine). X-ray pictures are taken while barium sulfate fills the colon via the rectum.

Procedure

A barium enema in a disposable bag manufactured for that purpose

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.

Preparation

Thorough cleaning of the large intestine is necessary for accurate pictures. Test preparations include a clear liquid diet or nothing at all (nihil per os or NPO) after midnight, drinking a bottle of magnesium citrate (a laxative), and warm water enemas to clear out any stool particles.

Purpose

A barium enema clearly displays a colonic herniation.

Barium enemas are most commonly used to check bowel health; they can help diagnose and evaluate the extent of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Polyps can be seen, though not removed during the exam like with a colonoscopy— they may be cancerous. Other problems such as diverticulosis (small pouches formed on the colon wall that can become inflamed) and intussusception can be found (and in certain cases the test itself can treat intussusception). An acute appendicitis or twisted loop of the bowel may also be seen. If the picture is normal a functional cause such as irritable bowel syndrome (IBS) may be considered.

In a healthy colon, barium should fill the colon uniformly and show normal bowel contour, patency (should be freely open), and position.

Additional conditions under which the test may be performed:

CMV gastroenteritis/colitis
Hirschsprung's disease
intestinal obstruction
intussusception (children)

Risks

X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of ionizing radiation.

A more serious risk is a bowel perforation.

Special considerations

CT scans and ultrasounds are now the tests of choice for the initial evaluation of abdominal masses, and colonoscopies are becoming the standard for routine colon screening for those over age 50 or with a familial history of polyps or colon cancer, although it is not uncommon for a barium enema to be done after a colonoscopy for further evaluation.

External links

Wikimedia Commons has media related to Lower gastrointestinal series.

Duplicated Colon on Barium Enema - MedPix Medical Image Database
RadiologyInfo - The radiology information resource for patients: Barium Enema
NIH page on barium enemas

Surgical procedures involving the digestive system (ICD-9-CM V3 42–54, ICD-10-PCS 0D)

Digestive tract

Upper GI tract

SGs / Esophagus	Esophagectomy Heller myotomy Sialography Impedance–pH monitoring Esophageal pH monitoring Esophageal motility study

Stomach	Bariatric surgery Adjustable gastric band Gastric bypass surgery Sleeve gastrectomy Vertical banded gastroplasty surgery Collis gastroplasty Gastrectomy Billroth I Billroth II Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneous endoscopic gastrostomy Hill repair Nissen fundoplication Pyloromyotomy

Medical imaging	Endoscopy: Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series

Lower GI tract

Small bowel	Bariatric surgery Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty

Large bowel	Appendicectomy Colectomy Colonic polypectomy Colostomy Hartmann's operation

Rectum	Abdominoperineal resection / Miles operation Lower anterior resection Total mesorectal excision

Anal canal	Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization

Medical imaging	Endoscopy: Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy

Stool tests	Fecal fat test Fecal pH test Stool guaiac test

Accessory

Liver	Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure

Gallbladder, bile duct	Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medical imaging: Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy

Pancreas	Frey's procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure

Abdominopelvic

Peritoneum	Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis

Hernia	Hernia repair: Inguinal hernia surgery Femoral hernia repair

Other

CPRs

Medical imaging (ICD-9-CM V3 87–88, ICD-10-PCS B, CPT 70010–79999)

X-ray/
medical radiography/
Industrial radiography

Medical:	Pneumoencephalography Dental radiography Sialography Myelography CXR Bronchography AXR KUB DXA/DXR Upper gastrointestinal series/Small-bowel follow-through/Lower gastrointestinal series Cholangiography/Cholecystography Mammography Pyelogram Cystography Arthrogram Hysterosalpingography Skeletal survey Angiography Angiocardiography Aortography Venography Lymphogram

Industrial:	Radiographic testing

3D / XCT

Medical:	CT pulmonary angiogram Computed tomography of the heart Computed tomography of the abdomen and pelvis Virtual colonoscopy CT angiography Computed tomography of the head Quantitative computed tomography Spiral computed tomography High resolution CT Whole body imaging Full-body CT scan X-ray microtomography Electron beam tomography

Industrial:	Industrial computed tomography

Other

Fluoroscopy

MRI

Ultrasound

Radionuclide

2D / scintigraphy

Cholescintigraphy Scintimammography Ventilation/perfusion scan Radionuclide ventriculography Radionuclide angiography Radioisotope renography Sestamibi parathyroid scintigraphy Radioactive iodine uptake test Bone scintigraphy Immunoscintigraphy

full body:	Octreotide scan Gallium 67 scan Indium-111 WBC scan

3D / ECT

SPECT gamma ray: Myocardial perfusion imaging

PET (positron):	Brain PET Cardiac PET PET mammography PET-CT

Optical laser

Thermography

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