Colon x-ray is a radiopaque technique for examining the large intestine with its retrograde filling with a contrasting barium suspension. It is performed to diagnose developmental abnormalities, scarring, colon tumors, chronic colitis, diverticulosis, fistulas. After a tight filling of the large intestine with barium suspension, the shape, location, length, extensibility, elasticity of the intestine, and the condition of the bauginia flap are studied with the help of an enema. After emptying the intestine from the contrast suspension, organic and functional changes in the colon wall are investigated.
Colon x-ray is indicated for disorders of the motility of the colon, abdominal pain syndrome, stool disorders (constipation, diarrhea), the presence of various impurities in the feces (mucus, blood, pus), anemia, “small signs” syndrome (unmotivated weakness, decreased appetite, weight loss). The purpose of the X-ray is to identify and clarify the nature of the pathology of the colon: malformations, tumors (polyps, cancer), inflammation (colitis), wall deformities, fistulas, cicatricial stenosis, etc. Colon x-ray is indispensable for the examination of patients after colon resections, allows to detect local recurrences of colon tumors, check the condition of the intestinal anastomosis.
Colon x-ray is not performed with severe somatic status, tachycardia, rapidly developing ulcerative colitis, suspected perforation of the intestinal wall. Due to the teratogenic effect, colon x-ray is not performed in pregnant women. Special care is required in the case of intestinal obstruction, diverticulitis, ulcerative colitis, loose stools with an admixture of blood, cystic pneumatosis of the intestine. Factors that can distort the results of colon x-ray are poor preparation of the intestine, the presence of barium residues in the intestine after previously conducted radiopaque studies (radiography of the small intestine, stomach, esophagus), the inability of the patient to retain barium in the intestine.
Since fecal masses prevent radiopaque imaging of the colon, careful preparation of the intestine is carried out before colon x-ray, including a slagless diet, cleansing enemas in the evening and in the morning to clean waters. Dinner on the eve of colon x-ray is not allowed. With bleeding from the gastrointestinal tract or ulcerative colitis, enemas and laxatives are not allowed.
Methodology of conducting
In the X-ray room, the patient is placed on an inclined table and an overview radiography of the abdominal cavity is performed. Then, under X-ray control, the intestines are filled with a barium solution (an aqueous suspension of barium sulfate heated to 33-35 °). At the same time, the patient is warned about the possibility of a feeling of bursting, pressure, spastic pain or urge to defecate and is asked to breathe slowly and deeply through the mouth. For better filling of the intestine in the process of colon x-ray, a change in the tilt of the table and the position of the patient, pressure on the abdomen is performed.
As the intestine is straightened, targeted radiographs are performed; after a complete tight filling of the lumen of the colon, an overview radiography of the abdominal cavity is performed. Then the patient is escorted to the toilet for bowel emptying. After removal of the radiopaque barium suspension, an overview radiograph is performed again, allowing to assess the relief of the mucosa and the evacuation function of the colon. Double contrast colon x-ray can be performed immediately after a simple colon x-ray. In this case, a metered filling of the intestine with air is performed.
After diagnostic, the patient is recommended to rest and drink plenty. Since the remains of barium are excreted from the intestine within 1-3 days, there is a staining of feces in white. After colon x-ray, the patient and medical staff should monitor the nature of the stool.
Interpretation of results
The radiographs show a uniform filling of the intestine with barium, the gausters are clearly defined. After evacuation of the barium contrast, the intestinal walls collapse, the correct feathery structure of the mucosa is visualized. During colon x-ray with double (barium + air) contrast, the intestine is evenly stretched, a thin layer of barium on the mucosa allows you to clearly see the relief. The presence of colon cancer (adenocarcinoma, sarcoma) during colon x-ray is defined as a filling defect that has clear boundaries between normal and altered mucosa. With circular stenosis of the intestinal lumen, the defect has the form of an “apple core”. To clarify the changes detected during colon x-ray, a colonoscopy with a biopsy is required.
With the help of diagnostic, in 80-90% of cases, it is possible to differentiate the signs of ulcerative colitis and Crohn’s disease. With nonspecific colitis, pathological foci come into contact and merge with each other, are localized in the lumen of the colon circularly. In Crohn’s disease, the foci are asymmetric, usually only in the right parts of the colon; superficial and deep ulceration, cracks, fistulas are found. With an appendicular abscess, signs of external compression of the cecum are determined during colon x-ray. With diverticulosis of the colon, extravasation (swelling) of the radiopaque preparation is detected on colon x-ray. Also, this method of diagnostic can reveal the presence of baggy adenomatous polyps, villous tumors, invagination and inversion of the sigmoid colon, irritable bowel syndrome, mesenteric thrombosis, and other pathologies.
After colon x-ray, abdominal pain, discomfort and urge to defecate may persist for some time due to overgrowth of the intestine. Formidable complications are the development of water intoxication, barium embolism, the occurrence of perforation of the intestinal wall, contrast congestion in the abdominal cavity and retroperitoneal space.