Septicemia following barium enema.

Reported is a case of septicemia following a barium enema. This is the fourth such case reported. Several factors may predispose to septicemia, including host factors and technical factors related to the barium enema procedure itself.     

Colonoscopically detected colorectal cancer missed on barium enema

The radiographs and clinical records of 26 patients with colorectal cancer missed on barium enema, and subsequently detected at colonoscopy, were reviewed to determine the cause of radiological error. Twenty (77%) of the patients were female. In 24 of 26 patients, anemia and/or rectal bleeding was a presenting feature. Fourteen of the 26 (54%) missed cancers were in the sigmoid colon, 10 (38%) in the ascending colon or hepatic flexure, and two (8%) in the rectum. Tumor size ranged from 20–100 mm. Fifteen were polyps, and 11 annular cancers. Fourteen (54%) were Dukes C or D tumors. Twenty-eight barium enemas in 23 patients were available for review: 86% were double-contrast studies. In 18 (76%), the cancer could be seen in retrospect and, in over half, the tumor was obvious. The dominant perceptive error was due to missing the lesion in the barium pool. Other major errors were missing the lesion en face or in overlapping loops. As most cancers were missed because of observer perceptive error, by both experienced and inexperienced radiologists, the authors recommend double reporting of all barium enemas.     

Colorectal cancer screening: a community case-control study of proctosigmoidoscopy, barium enema radiography, and fecal occult blood test efficacy

OBJECTIVE: To examine the effectiveness of screening proctosigmoidoscopy, barium enema radiography, and the fecal occult blood test (FOBT) in decreasing colorectal cancer mortality in a community setting. PATIENTS AND METHODS: In this population-based case-control study, cases comprised 218 Rochester, Minn, residents who died of colorectal cancer between 1970 and 1993. Controls were 435 age- and sex-matched residents who did not have a diagnosis of colorectal cancer. Screening proctosigmoidoscopy, barium enema radiography, and FOBT results were documented for the 10 years prior to and including the date of diagnosis of fatal colorectal cancer in cases and for the same period in matched controls. History of general medical examinations and hospitalizations was also recorded. RESULTS: Within the 10 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening proctosigmoidoscopy were 23 (10.6%) of 218 cases vs 43 (9.9%) of 435 controls; at least 1 screening barium enema radiographic study was done in 12 (5.5%) of 218 vs 25 (5.7%) of 435. Within 3 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening FOBT were 27 (12.4%) of 218 vs 44 (10.1%) of 435. Adjusted odds ratios were 1.04 (95% confidence interval [CI], 0.21-5.13) for proctosigmoidoscopy (distal rectosigmoid cancers only), 0.67 (95% CI, 0.31-1.48) for barium enema radiography, and 0.83 (95% CI, 0.45-1.52) for FOBT over the above time periods. CONCLUSION: In this case-control study within a community setting, a colorectal cancer-specific mortality benefit could not be demonstrated for screening by FOBT, proctosigmoidoscopy, or barium enema radiography. Screening frequency was low, which may have contributed to the lack of measurable effects.     

Colon preparation for the barium enema: a guide for the radiologist

One of the most important aspects of an accurate colon examination is patient preparation. This requires a thorough knowledge of the types and actions of cathartics as well as their potential hazards. In addition, other adjunctive measures can be applied to ensure good hospital staff and patient cooperation. A guide for the radiologist is presented.     

Ring artifacts on the barium enema

A specific ring artifact that is occasionally seen on barium enemas is described. The cause, appearance, and means of avoiding this artifact are discussed.     

Colonoscopy and the barium enema: a radiologic viewpoint

Adherents of colonoscopy are recommending that it replace the radiologic examination as the initial diagnostic study of the colon. We present the radiologic view, supporting the barium enema as a more practical approach to initial diagnostic evaluation. The radiologic examination is an equally reliable, less costly, and much safer method for detecting colonic disease.     

清洁灌肠预防钡剂灌肠后钡石形成的效果观察

[目的]探讨钡剂灌肠造影后清洁灌肠预防钡石形成的效果。[方法]将60例钡剂灌肠造影病人按检查日期单双日分为两组,每组30例。对照组钡剂灌肠检查后不予清洁灌肠,采用常规护理方法,如鼓励增加活动量、适当饮水、腹部环形按摩等。实验组在此基础上采用生理盐水加液状石蜡行清洁灌肠。[结果]造影完毕48h后实验组无一例发生钡石,对照组发生钡石8例,两组比较差异有统计学意义(P<0.01)。[结论]清洁灌肠能有效预防钡剂灌肠后钡石形成,防止肠梗阻等并发症的发生。     

CT colonography versus double-contrast barium enema for screening of colorectal cancer: comparison of radiation burden

Our aim is to compare the radiation dose associated with a low-dose CT colonography (CTC) protocol for colorectal cancer screening with that delivered by double-contrast barium enema (DCBE). CTC of twenty asymptomatic individuals (M:F = 10:10) participating to a colorectal cancer screening program and DCBE of fifteen patients (M:F = 6:9) were evaluated. For CTC, absorbed dose was determined by calculating the dose-length product for each CTC examination from measurements on a CT dose phantom equipped with a CT ion chamber. For DCBE, the free-in-air Kerma at the patient’s X-ray entry surface and the Kerma-area product during fluoroscopy and fluorography were measured with a Barracuda system, with fluoroscopy times being recorded blinded to the performing operator. Effective dose at CTC was 2.17 ± 0.12 mSv, with good and excellent image quality in 14/20 (70%) and 6/20 cases (30%), respectively. With DCBE, effective patient dose was 4.12 ± 0.17 mSv, 1.9 times greater than CTC (P < 0.0001). Our results show that effective dose from screening CTC is substantially lower than that from DCBE, suggesting that CTC is the radiological imaging technique of the large bowel with the lowest risk of stochastic radiation effects.     

False-negative barium enema in patients with sigmoid cancer and coexistent diverticula

The false-negative rate of barium enema examinations for the recognition of polypoid sigmoid cancer was evaluated in 167 patients with histologically proven carcinoma. The cases were classified according to the coexistence of sigmoid diverticula. In patients with less than 15 diverticula, 3.1% of lesions were missed, while in those with more than 15 diverticula, 20.4% of tumors were undetected. The overall error rate was 7.2%. Extensive diverticulosis is an important factor limiting the sensitivity of barium enema examinations for the evaluation of sigmoid masses.     

Diagnosis of colonic varices by air-contrast barium enema examination: Report of a case

A case of colonic varices presenting as serpiginous and tubular submucosal lesions in the sigmoid on air-contrast enema examination is reported. The associated angiographic and colonoscopic findings are illustrated, and the pertinent literature is reviewed.     

Intestinal tuberculosis: Findings on double-contrast barium enema

Seven cases of intestinal tuberculosis in an active stage were studied by the double-contrast barium enema (DCBE) method. Formerly, diagnosis of intestinal tuberculosis in the early stage by single-contrast barium enema (SCBE) and barium meals was based on functional phenomena, such as spasm and hypermotility of the ileocecal region. Presently, this can be better accomplished by DCBE. DCBE enables the detection of shallow ulcers with their characteristic elevated margins. These ulcers are frequently slim and transversally oriented. Confluence of ulcers may create whole girdle ulcers or affecte entire segments. In more advanced stages, characteristic deformities, also evident by SCBE, such as symmetrical annular stenoses, shortening, retraction, pouch formation, and the frequently observed pathology of the ileocecal valve and the cecal region, acquire a new dimension with DCBE.     

Portal vein gas following air-contrast barium enema in granulomatous colitis: Report of a case

Portal vein gas developed in a patient with granulomatous colitis following air-contrast barium enema. No symptomatology or morbidity could be attributed to the portal vein gas in this patient.     

Appendiceal filling by double-contrast barium enema

The barium enema is a safe and useful diagnostic modality in the evaluation of patients with suspected acute appendicitis. Complete appendiceal filling with barium virtually excludes this diagnosis. Frequently positive diagnostic information is obtained. Only 1 study in the literature documents the frequency of normal appendiceal filling by barium enema. The authors utilized the singlecontrast technique. We recorded the frequency of normal appendiceal filling with the double-contrast technique and then compared our data with the previously published study to determine if there is a significant clinical disadvantage to the doublecontrast technique when acute appendicitis is a diagnostic consideration.     

Rectal balloon catheters and the barium enema examination

Inflation of a rectal balloon during the barium enema examination has the potential for obscuring rectal lesions or causing rectal injury. The purpose of this communication is to emphasize a rationale for the radiologist that minimizes the use of rectal balloons and reduces the risk of rectal injury when inflation of a rectal balloon is necessary.     

Impact of the barium enema on patient management

The medical records of 214 consecutive inpatients who had a barium enema examination were reviewed, and the clinical indications, efficacy of the barium enema, and patient outcome were correlated to determine the impact of the barium enema on patient management. The most frequent indications were rectal bleeding (33%), abdominal pain (31%), anemia (17%), weight loss (12%), and previous lesions needing reevaluation (12%). Diverticular disease (30%), colonic polyps (10%), and primary or secondary malignancies (12%) were the most common abnormalities detected radiographically. The sensitivity of the barium enema for colonic neoplasms was 89%, with only 1 small cecal polyp being undetected. The effects of barium enema on patient management were serious pathology excluded (64%), diagnosis made that changed therapy (24%), existing therapy continued (10%), and a further study ordered (2%). No serious or life-threatening lesion was missed by barium enema.     

Pseudoulcerations of the colon on barium enema examination

Marginal spiculations and punctate collections of barium may occasionally be identified on barium examination in patients with a normal colon. These may be due either to filling of the crypts of Lieberkuhn with barium or retention of barium in the innominate grooves of the colon. Perhaps both combine to produce the radiographic findings. This normal variant must be carefully distinguished from actual ulcers associated with inflammatory bowel disease in order to avoid making a major error in diagnosis.     

Dietary fibers in the preparation of the bowel for diagnostic barium enema

The effect on colon cleanness of adding dietary fiber or placebo to a standard bowel preparation scheme before diagnostic barium enemas was tested in a randomized, double-blind study including 120 consecutive outpatients admitted for diagnostic barium enemas. Colon cleanness was scored as satisfactory, intermediate, or unsatisfactory. No case of unsatisfactory cleansing appeared in the group given fiber. Mean score was slightly better in the fiber group but the difference was not statistically significant. Dietary fiber does not have a negative effect on colon cleansing but may instead have a beneficial effect, which is possibly more pronounced in patients with constipation.