Stack of coin or

Herring bones
plain abdominal x-ray,
lateral position horizontal
ray

External hernia
4. Large Intestine = colon
Radiology modality :
Plain abdominal radiographs

Barium enema = colon in loop

USG / EUS

CT scan, virtual colonography

MRI

Nuclear medicine

Interventional Radiology
 Plain abdominal x-ray

Technique :
AP Supine
AP Erect
LLD
Semi
recumbent
CXR
Indication :
Acute
abdomen
plain abdominal x-ray

radio opaque stone soft tissue mass

 Mechanical large bowel
obstruction

Colon dilatation

obstruction.

Barium enema
volvulus of sigmoid
colon
Post operation complication :
Metallic clamp is found intrabdominal
 Plain abdominal x-ray

air in portal
vein

NEC
=
necrotizing
entero-
colitis
pneumatosis intestinalis
Hirschsprung dss:
Six (6) months old boy,
fecal retention in rectum
and dilatation of proximal
bowel.
Barium
Enema
= Colon in Loop
The routine examination of the colon

Technique :
Single Contrast : barium suspension
Double Contrast : barium susp.+ gas
 Colon Radiology Anatomy

Caecum - colon - rectum

Indication

Single contrast barium enema :

Intussusceptions
Diverticle dss/diverticulosis/diverticulitis
Colonic polyps
Colon and rectal carcinoma
Crohns dss
Hirschprungs dss
Fatique / very old patient / serious illness
Suspected pelvic metastasis
Indication

Double contrast barium enema :

Melena / bloody stool
Chronic diarrhea
Pain & abdominal discomfort
IBD (inflamatory bowel dss)
Diverticulosis
Suspected colonic carcinoma
Suspected colonic polyp / familial polyposis
Family history of colonic ca / polyp
Contraindication

Suspected bowel perforation

Toxic megacolon
After colonic biopsi
After snare polypectomy
Complication

Gas pain
Colonic perforation or colonic ruptur
Water intoxication
Colonic intramural barium
Rectal laserasion
Bactery contamination
Allergy / hipersensitivitas of barium or
glukagon/buscopan
Preparation

Patient preparation

Low residue diet

Increased fluid intake
Rectal or oral laxative (if needed)
Antispasmodic agent :
1. Glucagons : intravenous : 0,5 1 mg.
2. Buscopan (hyoscine N-butylbromide) : iv or
im : 1 ampul (20 mg/mL)
Contrast preparation

Barium sulphate suspension :

Single contrast : 12% - 25% w/v
Double contrast : 70% - 100 % w/v
Conventional digital fluoroscopy
Remote-control fluoroscopy
 4
1
Irigator preparation
Plastic irigator :
1. enema tip
2. enema tube
3. enema reservoir bag
4. retention balloon with its 3
inflator.

2
1

4
2
 Technique & positioning

A.
Left lateral position :
contrast filling
rectum and
rectosigmoid

B.
Left posterior
oblique (LPO):
contrast filling
sigmoid
C.
Left lateral with 15o
Trendelenberg position :
contrast flow to descendent
colon and lienalis flexure

D.
Clockwise to prone position:
contrast filling transversal
colon
E.
Clockwise to right lateral
with 15o Trendelenberg
position : contrast filling the
hepatic flexure

F.
From E, turn left to supine
position : contrast filling
hepatic flexure and
ascendant colon
G.
Turn to left posterior oblique
(LPO) to filling the
ascendants colon

H.
From G position, turn
clockwise to supine
position: contrast filling the
caecum
Recording / filming

Plain abdominal photo

Spot photo
Overhead whole abdomen

Plain abdominal photo

Barium
Enema
Single
Contrast
Spot film : Single contrast

Rectum (left lateral) Sigmoid Lienalis flexure

Hepatic flexure Caecum

Whole abdomen : single contrast

Whole colon :
overhead film

Overhead film
Barium
Enema
Double
Contrast
Spot film : double contrast

Rectum & sigmoid :

Lateral position Supine position Prone position

Spot film : double contrast

Distal descendant colon Proximal

Sigmoid :
descendant colon
posterior oblique
Spot film : double contrast

Lienalis flexure Transverse colon

(RPO)
Erect position
Spot film : double contrast
Ascendant colon

Hepatic flexure

Erect position Erect position, LPO

Spot film : double contrast
caecum & terminal ileum
Caecum & appendix