This document provides information on small bowel enema/enteroclysis procedure. It discusses the indications for the procedure including partial small bowel obstruction and Crohn's disease. It outlines the preparation process and describes how to position the Bilbao Dotter tube through the nose into the duodenum. The document discusses performing the procedure with single or double contrast and imaging techniques. Potential findings and complications are also summarized.
2. Radiological study of small bowel from
jejunum to ileocaecal junction by intubation
of the jejunum and instillation of contrast
through the tube.
a/k/a Small bowel enema
3. Partial small bowel obstruction
Crohns disease
Suspected meckels diverticulum
Malabsorption
Tumours of small intestine
Occult GIT bleeding
Equivocal BMFT but strong clinical suspicion
4. Complete colonic obstruction
Suspected perforation
Massive dilatation of small bowel
Duodenal obstruction and gastrojejunostomy
Paralytic ileus
5. Liquid diet for full day and over night fasting
before the procedure.
Dulcolax tablet in the evening preceding the
procedure.
No rectal enema.
NO drugs like tranquilisers , sedatives ,
antispasmodics or anticholinergic .
6. Bilbao Dotter Tube
22 F polyethylene tube
150 cm long
Multiple side(8) holes at the tip
with or without end hole
7. Contrast medium
Single contrast enteroclysis : 20% w/v
suspension of barium sulphate is used
Double contrast enteroclysis : 200 to 250% w/v
suspension of barium sulphate is used
8. Preliminary plain radiograph
Upright film
Determine whether the patient is adequately
prepared or not
Determining the best radiographic method
for evaluating the patient
9. Position of the patient
Upright
Supine or right lateral
Examination of Nasal cavity
Patients neck is hyperextended. Bilbao Dotter tube
without guide wire is introduced is inserted through
one of the nostrils and advanced with swallowing
action till it reaches the stomach.
10. Guide wire may be used to stiffen the tube to assist
advancement through the esophagus into the
stomach.
After 2/3rd of the tube is passed tip must be in
stomach.Under flouroscopic guidance the tube is
then advanced through antrum into pyloric canal.
Now with the guide wire 5cm proximal to the tube
tip,the tube is advanced till it reaches the duodenal
cap.
11. Advance the tip slowly keeping the guide wire 2-
3cm proximal to the pyloric sphincter . With each
advancement withdraw the guide wire .
At the end when the tube passes beyond the
duodenojejunal flexure . Guide wire will be in
pyloric canal.
Finally tube tip should be approximately 4-5cm
distal to Trietz ligament.
12.
13.
14. Prolonged examination
Incomplete distension of bowel
Prolapse of small bowel into pelvis
Faecal material in terminal ileum
15. Performed in patients with high grade partial
small bowel obstruction with significantly dilatd
bowel loops.
Avg amount of BaSO4 – 1 to 1.5 litres
Avg time to reach ileocaecal junction – 15mins
Stenotic lesions are best identified at head of
barium column.
18. 150 to 500 ml of barium suspension (80 to
100ml/min) is injected till proximal ileum is
reached
0.5% carboxymethyl cellulose is injected at
a rate of 75-120ml/min
Ileocaecal spots taken when barium reaches
the junction and then again when double
contrast is in.
Ileocaecal junction will be seen well in
double contrast immediately after the
patient defecates and spot films are taken.
19. Upper abdomen when
jejunum is seen
Ileocaecal
spots in single
and double
contrast
Entire
small
bowel
Complete filming in 20 –
25 mins
Erect filsms have no
additional information
20. Preparation
Laxatives night before examination
NPO after 7pm the night before procedure
Barium used : 50 to 70 % w/v barium sulphate
Advantage : Better mucosal details
Disadvantage :
Difficult procedure
Uncomfortable to patient
Air may pass through minimal narrowing and it
may be missed
21. 150 to 200 ml of
barium (60ml/min)
When barium
reaches distal ileum
600 – 1000 ml of air
(100ml/min)
When air reaches
distal ileum
Antispasmodic is
given
22.
23. Quick.
Tube may be left in place in patients with
obstruction for better decompression.
Better delineation of small bowel than BMFT.
Sinuses and fistulas are better demonstrated.
Contrast administration is not influenced by
action of pyloric sphincter.
24. Discomfort by placement of tube
Rapid colonic emptying
Operator dependent
Failure to depict extra intestinal changes
Nausea and vomitting due to inadequate
tube placement
25. Warn patients about diarrhoea due to large
volume of fluid infused.
Aspiration
Perforation
26.
27. MC congenital structural abnormality of GIT –
Meckels diverticulum
True diverticula
Inflammation of Meckels diverticulum is
meckels diverticulitis
32. T cell mediated autoimmune chronic gluten
intolerance
Loss of villi in proximal small bowel
Radiographic features
Small intestinal dilatation due to excess
fluids
Dilution of contrast
Moulage sign
Jejunoileal fold pattern reversal
Segmentation
33.
34. Affects esophagus , small bowel and colon.
Spares stomach
Atrophy of muscular layer and replacement
with fibrous tissue causing malabsorption.
Small
bowel
dilatation
Hide bound
appearance
Close
aproximation
of valvulae
35. Rare disorder
Caused by Tropheryma whipplei
Small bowel (jejunum) is a classical location
– Intestinal lipodystrophy
Hallmark findings
Nodules
Markedly thickened bowel wall –
Picket fence thickening
36. Gastrointestinal tumor of mesenchymal
origin arising from muscular layer of
intestinal wall
Solitary filling defect
in the jejunum.
Angles at the margin
is obtuse depicting the
intramural nature of the
tumor.
Normal mucosa/Bulls
eye lesion.
37.
38. Hybrid technique combining conventional
enteroclysis with that of abdominal CT.
Can be combined with I V contrast study.
Helical scanning done 70 secs after
administration of I V contrast.
Contrast media
Neutral
contrast
Positive
contrast
Water/ Methyl cellulose
IV contrast is usedwith neutral agents
Sodium diatrizoate/ Dilute barium
No IV contrast is used with positive agents
39.
40. Better detection of intraluminal , intramural
and extramural pathologies.
Even small lesion can be detected.
Measurement of bowel wall thickness
possible.
Detection of enteric fistulous tract and
stenosis possible.
41. Enteroclysis performed under MRI
Methyl cellulose in water as enteric coated
contrast agent with Gd-DTPA is preffered.