Barium studies of the small bowel

Barium studies of the small intestine are still considered an effective modality to show the bowel loops in a cost-effective way.

Procedure

Small bowel follow through (SBFT) or transit study 

• routine investigation for delineation of all parts the small bowel
• done with barium meal after having a quick look at esophagus, stomach, and duodenum

Enteroclysis

• improved technique to show small bowel mucosal pattern with double contrast (air and oral contrast) 
• a long tube is introduced and its tip is placed at the duodenojejunal angle and beyond
• a manageable pump is necessary for insufflation
• requires about 10 minutes or more fluoroscopy
• although the advantage of the technique is showing individual small bowel loops in great detail, increased radiation dose to the patient, and lack of the necessary tools for enteroclysis means it is not used routinely and it is often an academic technique

Double contrast imaging limited to the ileocecal region

• at the moment when the oral contrast column from the ileum enter the cecum, introduce air by insufflation into the colon
• as the ileocecal valve is patulous in 90% of people and air could easily enter the ileum, double contrast imaging is acquired for this region by this technique called peroral pneumocolon

Radiographic features

On a normal barium study of the small bowel, the jejunum is located in the upper left abdomen and the ileum in the lower right abdomen, to be continued by the colon in the ileocecal region. This configuration must be shown in any series of the small intestine. There is no definite border between jejunum and ileum, however, more than half of the small bowel is ileum.

The mucosa of the small bowel is characterized by the existence of the valvulae conniventes (also referred to as Kerkrin valves or circular folds). These folds start from the second part of the duodenum, which has a greater number of them, and they decrease in number as the small bowel approaches the ileocecal valve. With gaseous distension of the bowel loops, they are never completely effaced in the jejunum but they may be effaced in the ileum.

In the small intestine, a barium exam may reveal:

• malabsorption syndromes
• swelling and/or inflammation of the small intestine walls
• tumors
• ulcers
• intestinal obstruction

Contraindications for a barium swallow may include:

• suspected bowel perforation
• bowel obstruction
• conditions where aspiration of barium is likely

See also

• enteroclysis
• small bowel follow through (SBFT)