Features of modern irrigoscopy
Mar 05, 2018
Irrigoscopy refers to the traditional X-ray methods for studying the thick intestine by introducing a contrasting barium composition.The intestine, like most hollow organs, is not able to delay ionizing radiation, so with ordinary radiography it is "invisible".The barium mixture serves as a "simulator" of the investigated department, filling all the anatomical formations and pathological niches of the examined tract.Filling of the intestine comes from the rectum and above.
What can you see when using an irrigoscopy?
First of all, irrigoscopy allows you to consider:
- anatomical shape, topographic location relative to other organs, the size and uniformity of the lumen of the large intestine;
- the state of elasticity and the functional capacity of stretching the intestinal wall;
- The capacity of the buginium damper( a valve between the thick and small intestines) to allow passage of intestinal contents.Normally, the movement goes only in one direction - from the cavity of the small intestine to the thick.In case of insufficiency, a retrograde( reverse) cast is observed;
- contractile and evacuation function of the colonic tract;
- relief structures of the mucous for the detection of ulcerative defects, diverticula, fistulous passages, tumoral formations, structural abnormalities, scar changes of the colon.
. What is an indication for the appointment of an intestinal irrigation?
Irrigoscopy is prescribed by a gastroenterologist, proctologist, surgeon or therapist after examination of the patient, Clarifying his complaints, palpation of the abdomen, conducting laboratory tests.This method of X-ray diagnosis is carried out for the establishment of a primary diagnosis and control of the treatment.Also, the procedure is necessary for dynamic observation of the pathology of the large intestine.
Indications for the study are:
- cicatricial processes of the large intestine after surgery and inflammatory diseases;
- suspected of having large intestinal tumors;
- single and multiple diverticula( bulging intestinal wall);
- fistulous passages;
- chronic inflammatory processes;
- increase in the length of the large intestine( megacolon);
- abnormal lengthening of the sigmoid colon( dolichosigma);
- presence of frequent abdominal pain of unknown origin;
- unexplained constipation or diarrhea in the patient;
- monitoring the recovery of anatomy and bowel functions, after resection surgery;
- in the presence of blood impurities in intestinal contents;
- for evaluation of surgical anastomosis between intestinal walls.
Contraindications to conduction of intestinal irrigation
- should be kept out of the serious condition caused by coma, terminal conditions, acute myocardial infarction, stroke, acute respiratory and heart failure, pulmonary edema andEtc.;
- revealed signs of perforation of the intestinal wall;
- is pregnant;
Important: should be exercised with special care in the case of an "acute abdomen" clinic, diseases in which the patient needs urgent surgical care.If necessary, irrigoscopy is replaced by another type of diagnosis.
What is needed to prepare for the iriscope
The examination requires preliminary preparation of the intestine.
Dietary features of
First of all, you need a diet.It is prescribed 3 days before the procedure.From the diet it is required to exclude all the "heavy" food, which causes prolonged digestion with abundant calorification.Also, you should refrain from products that contribute to the occurrence of flatulence.
It is necessary to completely remove the porridges cooked from pearl barley, pshona and oatmeal from the menu.
Fresh vegetables are contraindicated:
- greens( dill, parsley, etc.);
- garlic and onion
- peas and beans;
Fruit should be discarded from the fruit before the irrigoscopy:
- of apples;
- of citrus fruits;
- plums, apricots and peaches;
Do not eat black bread.
In the period of preparation for irrigoscopy, a slag-free diet consisting mainly of protein products is recommended.In the diet should include low-fat meat, fish, eggs, a small amount of dried white bread, porridge from semolina.
The day before the irrigoscopy, you should switch to liquid food.It is best to use low-fat broth, fruit jelly, neutral compote, green tea.Meat broth should be without cook, all dishes must be taken only in boiled form, or cooked for a couple.In addition, you need to drink 2 liters of water.Dinner is better to miss and do not have breakfast on the day of the survey.
More details on the rules for preparing for GI studies are described in the video review:
Preparatory bowel cleaning
More recently, the classic bowel preparation for irrigation was based on cleansing enemas on the eve of the day of the procedure and in front of it.The volume of one enema was approximately 1 liter.Purification was carried out until the disappearance of stool content and the appearance of clean washing water.Enema is currently used in the case of contraindications to the appointment of laxatives or in emergency situations.
Note : at the current stage, most clinicians have opted to prepare the intestine for irrigation using laxatives.
The most common drug for this purpose is Fortrans.Preparing a drug solution in a volume of up to 3-4 liters, depending on the weight of the patient, is drunk on the eve of the examination.After that, medicamental diarrhea occurs, but without loss of electrolytes.The drug is virtually devoid of side effects.
There is a more "easy" way of "laxative preparation" - Fleet Phospho-soda.The first glass of the drug is taken the evening before the study, and the second one - early in the morning.The effect develops quickly and qualitatively.It lasts a short time.The only drawback of this drug is contraindications.With concomitant pathology, it can cause convulsive syndrome, arrhythmias, kidney problems, dehydration.Therefore, when he is appointed, you should be very careful.
The method of cleaning with "salt water" was tested.This method is not common in clinical practice, and we will not discuss it in detail.
Some doctors use Dufalac to prepare.The action of the drug causes flatulence and other undesirable effects, so the application of Dufalac is limited.
How Irrigoscopy of the Intestine Is Made
Irrigoscopy can be of two types:
- with the usual contrast of the barium mixture;
- with double contrasting with the help of air pumped into the intestines.
Note: in the first case, a tight filling of the gut with barium, makes it possible to see the normal contours of the large intestine.The second method serves to identify intracavitary tumors, ulcerative processes of the mucosa and inflammatory necrotic areas.
Often before the examination, the patient is assigned a conventional X-ray without contrast.
Irrigoscopy uses modifications of Bobrov's apparatus, which include a volumetric reservoir for intaking enteric mixture with two outgoing tubes.
One tube is connected to a rubber-plastic pear, used to inject air.The second tube contains a tip, for insertion into the anal opening of the patient.Pear helps to evenly enter and distribute the contrast solution in the cavity of the colon.When it is squeezed, the liquid under the pressure of air is fed into the tube with a tip.
The patient is laid on his side, the tip is inserted into the rectum.Then begins the process of filling the lumen of the colon with a contrast solution under the control of fluoroscopy, which makes it possible to observe the uniformity of the distribution of the diagnostic composition.
Barium sulphate lines the entire relief of the investigated areas.The radiologist makes the pictures necessary for the subsequent analysis.When the barium reaches the lumen of the cecum, the procedure is completed and the patient is sent to the bowel movement.
After complete liberation of the intestine, the study continues.His lumens with the existing pathology are cleared from contrast completely, healthy retain a certain amount.
The purpose of the second stage of "X-ray" is the detection of these "dark" zones against the background of contours and the relief of a normal, unchanged intestine.
Note: to improve the picture, the radiologist can apply double contrasting.In this case, simply air is introduced through Bobrov's apparatus.Doubtful researched contours thus appear more clearly.
Irrigoscopy is a procedure that is almost painless, non-traumatic, and less radiation-sensitive than computed tomography.Therefore, if there is a need for an X-ray examination of the large intestine, this technique is used.Unpleasant sensations can arise only from the filling of the intestine with air, but they do not last long and quickly pass.
The duration of the examination usually takes no more than 40-45 minutes.
How Irrigoscopy Works for Children
In pediatric practice, irrigoscopy is used only in the most necessary cases due to the severity of the child's preparation for the procedure.In some children suffering from functional intestinal obstruction, the intestine may "open" under the influence of a solution of barium sulphate.
Important: , despite the emergence of modern diagnostic radiotherapy - computed tomography, MRI, irrigoscopy has not lost its relevance and remains one of the main methods of research of the large intestine today.
Alexander Lotin, radiologist,