Intestinal irrigoscopy: the essence of the study, preparation and procedure

It is very difficult to accurately determine this or that bowel disease without instrumental examination methods. Modern medical centers offer various diagnostic techniques with the help of which intestinal pathologies are detected.

One of the most popular medical procedures for examining the colon is an irrigoscopy (irrigography).

What it is, what diseases can be diagnosed with it and how it is carried out, you will learn from this article.

What

Irrigoscopy means a method of examining the large intestine, which is carried out using X-ray equipment and a contrast agent introduced into the intestine by the rectal method. Barium sulphide acts as a dye.

Unlike colonoscopy, which is also used to detect intestinal pathologies, the method is considered safer in terms of radiation exposure, but no less informative. Using this technique, the doctor is able to accurately identify diseases such as Crohn's disease, cancer intestines, diverticulitis and other intestinal pathologies, as well as to assess the peculiarities of functioning organ.

The method of irrigoscopy reveals pathologies of the rectum, sigmoid colon, ascending, transverse and descending sections of the colon. The procedure has many positive reviews and is affordable.

Types of irrigoscopy

The introduction of a contrast agent and air into the intestine makes it possible to detect various neoplasms, ulcers and inflammatory processes.

Irrigoscopy, carried out only with the use of a dye, better reflects the physical characteristics of the organ, that is, in the picture, the natural contours of the intestine are seen more clearly.

Depending on the alleged pathology of the large intestine, the diagnosis is carried out in two ways:

• double - with dye and air;
• simple - only with a solution of barium sulfate.

Research essence

Irrigoscopy is carried out in the premises of a medical institution with special equipment. The contrast agent is injected into the rectum using a tube. At this time, the specialist performs X-rays several times. If the air method is used, it is pumped into the rectum after the solution is withdrawn from it, and then an X-ray is taken.

The intestines are filled with a special device called the Bobrov apparatus. It is a container with a volume of up to three liters, with two flexible silicone tubes. Through one tube, a contrast agent is supplied, and through the other, in order to create pressure, air is injected with a pear. Colon images are taken with X-ray equipment.

The procedure does not require anesthesia, but it can cause discomfort when the intestines are filled with air or contrast agent. The research time takes from fifteen to forty-five minutes. The results of an irrigoscopy are interpreted by a doctor immediately or after a few days, depending on the capabilities of the clinic.

The principle of this diagnostic method is based on the ability of X-rays to penetrate the intestine, which allows you to see an image of this organ. If you take a regular X-ray, then the intestines are barely visible on it, and its features are not visible. When using a solution of barium sulphide, the invisible organ acquires a clear outline, allowing you to see not only its physical parameters such as the shape and location of the intestine, but also its functionality, for example, the elasticity of the walls, as well as the presence neoplasms.

What can be seen during irrigoscopy

Normally, the image will display a swollen colon with clear physiological curves. The images of the mucous membrane have a smooth structure with a feathery pattern, without the presence of ulcerative surfaces and formations.

If any pathology is present, then it is noticeable along the boundaries of diseased and healthy tissues. After the contrast agent is withdrawn, the intestine is "deflated" to its natural state.

The doctor makes a diagnosis based on the results of an irrigoscopy, guided by the following indicators:

• the shape, curves and location of the colon;
• the presence of narrowings, adhesions in the lumen of the intestine;
• elasticity and extensibility of organ tissues;
• folding of the intestinal walls (gaustars);
• the work of the Bauhinia valve (intestinal fold, which is responsible for the movement of feces in one direction);
• the presence of scars, neoplasms, ulcers, polyps.

Bowel irrigoscopy: indications, contraindications and preparation for the procedure

This medical study is prescribed to a patient if the coloproctologist suspects that he has rectal pathologies: ulcerative or chronic colitis, cancer, Crohn's disease, diverticulitis, hemorrhoids, irritable bowel syndrome, polyposis.

The following symptoms may serve as the basis for intestinal irrigoscopy:

• chronic constipation;
• persistent diarrhea;
• acute intestinal obstruction;
• the presence of blood in the stool or bleeding;
• the presence of purulent or mucous contents in the feces or discharge from the anus;
• soreness in the anus.

Bowel irrigoscopy is often prescribed if the patient has contraindications for colonoscopy. This method of research is a priority if the patient is suspected of having bowel cancer, as it gives the best results. It should be noted that bowel cancer, in particular, metastatic colorectal cancer, in Russian and European medicine is treated with innovative drugs Lonsurf and Stivarga (based on regorafenib).

Contraindications

The method of irrigoscopy has few contraindications.

It is not prescribed to patients in the following cases:

• during the period of gestation, as there is X-ray radiation that negatively affects the fetus;
• with a severe course of the disease (strongly weakened);
• in the presence of serious heart pathologies;
• in the acute phase of inflammation in the organ;
• at risk of rupture of the intestinal wall.

If ulcerative colitis or diverculitis is suspected in a patient, then the procedure is carried out very carefully, supplying a solution with a dye and air into the intestine at the lowest possible pressure. If the intestine is filled quickly, it can lead to a violation of the integrity of the intestinal wall.

What is included in the preparation for irrigoscopy

Before carrying out the procedure, the patient needs to perform a number of measures aimed at cleansing the intestines. Preparation for the procedure consists in organizing proper nutrition and thoroughly removing feces from the intestines on the eve of the procedure. The accuracy and reliability of the study depends on how well the patient fulfills all the doctor's prescriptions.

Diet

Preparation for an irrigoscopy begins with a diet. The diet should be changed at least three days before the study. It excludes those foods that can cause intake, diarrhea, or increased gas production. Certain fresh vegetables and fruits may contribute to bloating, so avoid legumes, bananas, cabbage, apples, carrots, peaches, and beets.

A number of cereals should be excluded: millet, oatmeal and barley, as well as greens and rye bakery products. Kvass, sweet soda and coffee cannot be used from drinks.

It is also not recommended to eat ready-made meat products (sausage, boiled pork, etc.), meat broths, fatty fish. It is not recommended to fry food products in oil.

It is useful to eat porridge made from semolina or rice, bread crumbs, lean meats or fish. It is better to drink fermented milk products and green tea. On the day before the study, you must consume two and a half liters of clean water. For lunch, you can eat light plant foods, and you should refrain from dinner. On the day of the study, you can eat only after the procedure.

Bowel cleansing methods

On the eve of an intestinal irrigoscopy, one of the cleansing procedures should be carried out: washing with an enema, taking laxative medications or medical washing. Osmotic drugs are prescribed by a doctor, usually Fortrasn, Lavacol or Fleet.

• Cleansing enema - an inexpensive, safe and reliable method of preparing for an irrigoscopy. However, this procedure is not suitable for everyone, especially since it must be performed several times - twice in the evening the day before and twice in the morning on the day of the study. Before the first enema, it is recommended to drink a couple of spoons of castor oil. You need to enter one and a half liters of clean water into the intestines, wait a while, and then empty the intestines. An hour later, the procedure is repeated. The same manipulations should be carried out in the morning. The procedure is successful if clear water comes out when the colon is emptied.
• Fortrans drink on the eve of research. One sachet of the drug is diluted in a liter of clean water. You need to take an osmotic agent two hours after the last meal. In just a day, you need to drink four packets of Fortrans. The liquid is drunk slowly in small sips - one glass in fifteen minutes. In case of a gag reflex, you can take a Motilium tablet or suck on the pulp of a lemon.
• Lavacol begin to take twenty hours before the procedure. Preparation for an irrigoscopy with this drug is similar to taking Fortrans, with the only difference that Lavacol is better tolerated, but it can also cause nausea. One sachet of the drug is diluted in a glass of water. In total, fifteen sachets are used, which corresponds to three liters of liquid that must be drunk.
• Fleet, unlike previous medications, does not require a lot of fluid. It is necessary to dilute the bottle with the drug in one hundred milliliters of water. One to drink instead of lunch, the second - in the evening (food can not be taken). The medicine should be washed down with three glasses of green tea, juice without pulp, or clean water.
• Colon hydrotherapy carried out in a clinic. The patient can be offered such a service if available in the clinic. It consists in flushing the intestines with plenty of water, up to thirty liters. Colon hydrotherapy is carried out immediately before the study.

Intestinal irrigography: research progress and possible complications

Before the procedure, the doctor explains to the patient in detail all the details of the study and gives recommendations. Then he prepares the equipment and dilutes the barium sulfate in water. Before filling the apparatus with liquid, it is heated to thirty-five degrees.

Research progress:

• The patient lies down on the table surface in a certain position - on his side, his arms are behind his back, and the bent legs are pressed to the stomach.
• The specialist inserts the tip shallowly into the anus and begins to fill the intestines with the solution.
• As the fluid enters the large intestine, the patient takes different positions - turns on his back, stomach or other side, in the direction the doctor tells him to. This is necessary so that barium sulphide is evenly deposited on the intestinal walls.
• During bowel irrigography, the specialist several times turns on the X-ray machine, which captures the image of the organ. The last image is taken with a completely full intestine (tight contrast).
• The specialist removes the tip of the apparatus from the anus and the patient is emptied. Then another X-ray of the empty bowel is taken.
• If bowel irrigography is performed using a double contrast technique, then the next step is the doctor fills the intestines with air and takes several pictures. When using this technique, even the smallest changes in the mucous membranes, whether it be an ulcer or a neoplasm, can be detected in the picture, since all the folds of the intestine are smoothed out.

When diagnosed, the patient may experience discomfort while filling the intestines with solution or air. The patient should be patient, move softly and smoothly so as not to cause undue stress. After removing the fluid from the intestine, there will be no trace of discomfort. Over the next few days, it may be difficult for the patient to empty. Laxative medicine can be taken to normalize the stool.

In some cases, bowel irrigography does not give a complete picture due to the inaccessibility of some parts of the organ, in this case, in addition to this procedure, a colonoscopy is prescribed.

What can be seen in the picture, depending on the symptoms:

• If there is blood, pus, and mucus in the stool, the image usually shows ulcers, infiltration, or polyps. Inflamed areas look like a thickening of the intestinal wall, and polyps look like mushroom bulges.
• In acute intestinal failure, the contrast agent reaches the site of critical narrowing and does not pass further, thus determining the area where scarring, kinking or pinching has occurred.
• Painful sensations in the anus and rectum may indicate the presence of inflammatory processes, polyps, tumors and diverticulums. Cancer tumors look like round formations with a smooth or uneven surface, and a diverticulum is determined by the protrusion of the intestinal wall.
• Chronic diarrhea is accompanied by an increased tone of the intestinal walls. This can be seen in the picture by the excessive folding of the intestine.
• Chronic constipation is associated with decreased bowel tone. This pathology is visible in the form of smoothed intestinal folds.

Possible complications

Bowel irrigography is a fairly safe procedure. If all contraindications are taken into account and the study is carried out carefully, then there should be no unpleasant consequences. The most dangerous complication can be a violation of the integrity of the intestinal wall.

If this happens, the patient will need emergency bowel surgery. Seek medical help if a person has symptoms such as dizziness, vomiting, fever, and blood is leaking from the anus.