The document describes a radiological study called small bowel enema enteroclysis, which uses contrast medium to evaluate the small intestine from the jejunum to the ileocecal junction for abnormalities. It details the procedure, patient preparation, the equipment used, and the indications and contraindications for the study. Additionally, it outlines the advantages and disadvantages of the procedure, as well as potential complications.

1. SMALL BOWEL
ENEMA
ENTEROCLYSIS
by
poovarasu

2. This is the radiological study which used
to demonstrate the abnormalities in the
small bowel from jejunum to the ileocaecal
junction by administration of contrast
medium through Bilbao – dotter tube.
Introduction

3. Anatomy
Small intestine :
✪ It is the longest part of alimentary canal
✪ Extends from pylorus of stomach to ileocecal junction
✪ Length 6m & Diameter 4cm
✪ It occupies all abdominal regions except epigastric and hypochondriac region normally
✪ It is stabilized by mesentery
Organizing information
logically
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adipiscing elit. Nam semper gravida egestas.
Nam urna magna, aliquet et orci vel, mollis
bibendum sem. Curabitur elit ligula, fermentum
quis libero vel, mattis ultricies neque. Phasellus.
Anatomical sub division
★ Duodenum
★ Jejunum
★ Ileum

4. ✺ Partial small bowel obstruction.
✺ Crohn' s disease-to know its extent.
✺ Suspected Meckel' s diverticulum.
✺ Malabsorption.
✺ Tumors of small intestine.
✺ Occult GIT bleeding.
✺ Equivocal BMFT but strong clinical suspicion.
Indication
Contra Indication
⍟ Complete colonic obstruction.
⍟ Suspected perforation.
⍟ Massive dilatation of the small bowel.
⍟ Duodenal obstruction and gastrojejunostomy.
⍟ Paralytic ileus.

5. Bilbao Dotter tube:
✵This is a 22F polyethylene tube which is 150 cm long.
✵The tube is 5 cm longer than the guide wire in order to eliminate
the risk of perforation by the wire protruding beyond the tip.
✵The tip has multiple side holes with or without an end hole. Usually there
are 8 holes.
✵The guide wire is teflon coated to reduce friction.
Equipments

6. Contrast media
For single contrast enteroclysis:
20% w /v suspension of Barium sulphate is used.
For double contrast enteroclysis:
High density low viscosity Barium sulphate suspension is ideal which is 200-
250% w /v.
We can use 95% Microbar which can be diluted to 70% to decrease the
viscosity.
Another important constituent is carboxy-Methyl-cellulose (CMC). To prepare
this, add 10 gm of C.M.C. to 2 litres of warm water and mix well. Then refrigerate
the mixture overnight.Shake this mixture well before use.

7. Patient preparation
❂ The patient is advised to follow low – residue diet 2 days before the examination.
❂ Two or four Dulcolax tablets are given to the patient for bowel preparation in the
evening before the next day’s examination.
❂ The patient should be instructed to stop taking medication before the examination
E.g.,Tranquilizers, sedative, and antispasmodics.
❂ The pharynx is anesthetized with lignocaine gel/spray before procedure begin
Procedure
❂ The preliminary plain radiography of the abdomen is taken before starting of the
procedure.
❂ The patient sits in a chair with steadily against the wall and neck is hyperextended.
❂ 2 – 3 cc of 2% Xylocaine gel applied on the tip of the tube and introduced into the
nostril.
❂ After placing the tube at the epiglottis, ask the patient to make swallowing action,
which leads to tube entering the esophagus into stomach.

8. ❂ And make sure that, ask the patient to cough and ensure that the tube is in the
esophagus and not in the trachea.
❂ About 5 – 7 cm of tube is passed in stomach and then neck is normally flexed.
❂ After passing 2/3rd of tube, the tip must be in the stomach and guide wire 5 cm proximal
to the tube tip.
❂ Then the tip slowly enters into duodenal cap by, turning the patient prone with LPO
(right side down oblique) may help the tube to reach pyloric canal by gravity.
❂ Once the tube tip enters the first part of the duodenum, introduce the tube slowly with
the guide wire 2 – 3 cm proximal to the pyloric sphincter.
❂ After that, the tube will be in duodeno – jejunal flexure and the guide wire in the
pyloric canal.
❂ Finally, the tube tip placed approximately 4 – 5 cm distal to Treitz ligament.

9. Single contrast study
✬ Barium suspension 20% w /v. is injected at the rate of 75 to 120 ml/minute.
✬ Care should be taken to ensure that no air goes in during the injection.
✬ An average of one to one and half litres of barium sulfate is injected
without any interruption.
✬ The average time taken to reach the ileo caecal junction is about 15 mins.
Organizing information
logically
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Nam semper gravida egestas.
Nam urna magna, aliquet et orci vel, mollis
bibendum sem. Curabitur elit ligula, fermentum
quis libero vel, mattis ultricies neque. Phasellus.
Filming
❃Take one 10 x 12 spot film for the jejunal loops.
❃Another film is taken for the entire small bowel.
❃Spot films are taken with or without compression wherever necessary.
❃Spots of the ileo caecal junction are included with and without compression.
❃All the filming is done with high kV technique (120-140 kV).

10. Double contrast study
❋ 150 to 500 ml of barium suspension (high density and low viscosity) is injected
at the rate of 80-lO0ml/minute, till the proximal ileum is reached.
❋ After this,0.5% suspension of CMC is injected at a rate of around 75-120 ml/min
using a mechanical injector.
Filming
✮ Upper abdomen when jejunum is seen in double contrast.
✮ Full abdomen when entire small bowel is in double contrast.
✮ Ileocaecal spots in single and double contrast.
✮ Spot films as required.

11. 150-200 ml of Barium. (60 ml/min)
When barium reaches distal ileum
600 - 1000 ml of AIR (100 ml/min)
When AIR reaches distal ileum
ANTISPASMODIC agent is given.
AIR DOUBLE CONTRAST STUDY
✰ Laxatives are given the night before the examination.
✰ Nothing is to be taken by mouth after 7 pm the night before the examination.
Preparation
Procedure

12. ✧ The mucosal detail seen on the air double contrast study of the small
intestine is superior to any other examination.
✧ Aphthoid ulcer and minute scar can be picked up easily.
Advantage
Disadvantage
✤ Difficult to reproduce
✤ Uncomfortable to the patient
✤ Air may pass through the minimal narrowing and mild narrowing
may be missed
Comparison

13. Aftercare
❆ The patient should be warned that diarrhoea may occur as a result of
the large volume of fluid given.
❆ Patient can take full diet following the procedure.
Organizing information
logically
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Nam semper gravida egestas.
Nam urna magna, aliquet et orci vel, mollis
bibendum sem. Curabitur elit ligula, fermentum
quis libero vel, mattis ultricies neque. Phasellus.
Complications
❅ Aspiration.
❅ Perforation of the bowel.

14. Thank You