RadteraBarium Enema (Single / Double Contrast)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Colorectal mass / polyp / carcinoma (where CT colonography/colonoscopy unavailable)
- Diverticular disease
- Inflammatory bowel disease (chronic; avoid in acute toxic colitis)
- Suspected colonic stricture or obstruction
- Evaluation of anastomosis or fistula
- Reduction of intussusception (pediatric — usually air/water-soluble preferred)
Patient prep
- Thorough bowel prep: clear liquids day before, cathartic (e.g., magnesium citrate/bisacodyl) and/or cleansing enema per protocol
- NPO after midnight
- No prep / use water-soluble if obstruction, suspected perforation, or recent biopsy/anastomotic concern
Contrast
AgentBarium sulfate suspension (high-density for double-contrast, medium for single-contrast) with room air or CO2 insufflation for double-contrast; water-soluble iodinated (e.g., Gastrografin/diluted) if perforation/obstruction or postoperative leak
Routerectal
DoseGravity-fed barium to fill colon; air insufflation for double-contrast distention
TimingReal-time fluoroscopy during filling and after
Technique
- Insert enema tip (retention balloon only if no obstruction/rectal pathology contraindication); confirm position
- Optional IV glucagon to reduce spasm
- Single-contrast: fill colon with medium-density barium under fluoroscopy to cecum; compression spots
- Double-contrast: coat with high-density barium, drain, then insufflate air; rotate patient to distribute
- Multiple obliquities and decubitus views to distend all segments and overcome overlapping loops
- Document reflux into terminal ileum
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Scout abdomen | AP supine | Pre-contrast, residual stool, free air |
| 2 | Filling/spot images | Multiple obliquities | Rectum, sigmoid, splenic/hepatic flexures, cecum |
| 3 | Right lateral decubitus | Decubitus (double-contrast) | Distends non-dependent colon |
| 4 | Left lateral decubitus | Decubitus (double-contrast) | Distends opposite segments |
| 5 | Prone cross-table / angled rectosigmoid | Prone or angled | Unfolds rectosigmoid |
| 6 | Post-evacuation | AP | Mucosal pattern, residual lesions |
Key points
- Use water-soluble iodinated contrast (not barium) if perforation or near-obstruction suspected or recent deep biopsy/anastomotic concern — barium peritonitis is dangerous
- Avoid in suspected toxic megacolon / acute severe colitis (perforation risk)
- Limit balloon inflation; avoid in low rectal lesions/recent surgery
- Double-contrast superior for polyp/mucosal detection; single-contrast better for obstruction/fistula and frail patients
- Glucagon reduces spasm and improves distention (mind contraindications)
References
• ACR–SPR Practice Parameter for the Performance of Contrast Examinations of the GI Tract
• Radiopaedia: Barium enema
• ACR Appropriateness Criteria: Colorectal Cancer Screening
• Radiopaedia: Barium enema
• ACR Appropriateness Criteria: Colorectal Cancer Screening
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.