Enteroclysis: The Small Bowel Enema (cont.)
Administration of the Contrast Material
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- The barium suspension can be administered
by hand from a syringe or by gravity flow from an enema bag. However,
maximum success of the procedure is gained by having a constant flow rate
of the contrast medium. This can be achieved with the use of either a hand
pump (Jack Rabbit Pump, Black & Decker) or, better, with an electric
hemodialysis pump with digital readout of flow rates (MiniPump, Renal
Systems, Minneapolis, MN).
- A flow rate of 75 ml/min seems ideal for
most examinations, and small bowel transit will be accomplished in 5 - 10
minutes. A slower flow rate may lead to incomplete filling of bowel loops,
and a faster rate frequently causes excessive distention of the bowel
which leads to bowel paralysis and prolonged transit times. Reflux into
the stomach is associated with a considerably prolonged study. To avoid
small bowel over distension, ileus, and gastric reflux at the beginning of
the study, we start with an infusion rate of 50 ml/min and gradually
increase the rate towards 75 ml/min. If duodeno-gastric reflux or
decreased small bowel peristalsis is seen, the infusion rate is adjusted
downward until these signs disappear.
- For biphasic-contrast enteroclysis, infusion of the 0.5% methylcellulose solution immediately follows the barium infusion, usually at the same or a faster rate. Just as with the infusion of the barium sulfate, it is important to avoid significant gastric reflux.
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