Presentation
Abdominal pain and diarrhea
Patient Data
Technically good small bowel enteroclysis. It is normal.
Case Discussion
Fluoroscopic small bowel enteroclysis is rarely performed these days, but still has utility in specific situations. Another term for the study is a "small bowel enema," which captures the spirit of the exam -- an enteric tube is passed to the level of the ligament of Treitz and then air, CO2, or methylcellulose as well as medium-consistency barium is administered to distend and coat the small bowel, respectively.
The study can provide very high spatial resolution images of the small bowel -- particularly the proximal small bowel. These high resolution images are useful for evaluating the small bowel folds (valvulae conniventes) and evaluating the small bowel walls for polyps/masses. The indications are similar to those for push enteroscopy and capsule endoscopy which have mostly replaced it, and enteroclysis can be thought of as an option if these are not possible.
The study is only rarely performed because it has some significant downsides. It is time consuming and requires experience to get the combination of distention and coating right. This experience is now in short supply. It also requires placing an enteric tube, which is unpleasant for patients and requires distending up the small bowel, which can be even more unpleasant. These exams are often performed under sedation.
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