Air enema

Enema reduction is the standard non-operative method of treatment of intussusception. This may be guided with fluoroscopy when a barium, water-soluble, or air enema is used. US guidance is used... 

Table 1.3. Advantages and disadvantages of air enema therapy Advantages...

Fig. 1.54a,b. Air enema therapy, a Image obtained at the beginning of an air enema study shows the meniscus sign and a mass in the middle of the upper abdomen, b Image obtained after complete reduction shows gas passing freely into the small intestine [From del Pozo (1999)]... 

Miller SF, Landes AB, Dautenhahn LW et al (1995) Intussusception ability of fluoroscopic images obtained during air enemas to depict lead points and other abnormalities. Radiology 197 493-496... 

Fig. 6.8a,b. Appearance of intussusception during reduction by air enema, a The soft tissue mass of the intussusception can be seen in the right flank and the remainder of the large bowel is distended by air. Air has not yet flooded back into the small bowel, which would indicate successful reduction, b Air enema in a different patient the intussusception is shown as a soft tissue mass but perforation of the bowel has occurred... 

Whilst this is still a relatively new technique it is reported to have similar success rates to the fluoroscopic air enema technique (Yoon et al. 2001). Yoon et al. describe their technique as follows A balloon... 

The preferred reduction technique is either that of the air enema under fluoroscopic guidance or of air or hydrostatic enema under ultrasound guidance. The only absolute contra-indication to attempted enema reduction is full thickness bowel necrosis (which will present with features of shock and peritonitis) or if there is imaging evidence of perforation with free air. 

Cholera is a dreadful disease. It causes diarrhea so severe that a person suffering from it can lose as much as ten liters of water in a day. If left untreated, cholera can lead to rapid dehydration and death within a few days. The disease first appeared in Europe in 1831, an import from the Indian subcontinent, where it was endemic. Over fifty-thousand Britons died within a year, sparking widespread panic. Physicians didn t know what to do. They plied their patients with arsenic and strychnine, they gave them tobacco enemas, they wrapped them in flannel soaked in turpentine, they bled them with leeches, and they blistered them with nitric acid. All, of course, to no avail. No one knew what caused the disease, but the prevailing opinion seemed to be that cholera was somehow transmitted by the bad air, or miasma, that emanated from the sick and from garbage. One London dentist actually announced that the... 

After a barium enema, perforation occurs rarely in children and debilitated adults or when the colon is already weakened by inflammatory, malignant, or parasitic diseases. Perforation can be triggered by manipulations involved in giving the barium enema or can result from hydrostatic pressure. In one case, perforation followed air contrast insufflation for barium enema in a patient in whom the sigmoid colon became trapped in an inguinal hernia. 

In air-contrast examinations, colonic perforation can actually precede the administration of the barium enema itself. In such cases it is due to the preparatory insufflation of air if this is conducted with excessive enthusiasm in a high-risk patient (for example an elderly patient with a hitherto unrecognized epigastric hernia) (10). 

Aqueous foams are formed from a three-dimensional network of surfactant films in air. Foams can be used as formulations for the delivery of enemas and topical products. Foams which develop in production of liquids or in ampoules are troublesome hence there is an interest in breaking foams and preventing foam formation. The breaking and prevention of liquid foams is less well understood than the stabilisation of foams, it is recognised, however, that small quantities of specific agents can reduce foam stability markedly. There are two types of such agent ... 

Fig. 1.19a-e. Ileal atresia, a-c Supine, lateral, and upright abdominal radiographs show multiple dilated air-filled bowel loops occupying the entire abdominal cavity, with air-fluid levels in the upright radiograph. Note in (b) the absence of air in the rectum. With this degree of distension it is impossible to differentiate the small bowel from the colon. d,e Contrast enema outlines the minute size of the colon corresponding to an unused colon... 

The clinical presentation of patients with small left colon syndrome is very similar to that of patients with meconium plug syndrome. Air-fluid levels are often absent in the upright film, particularly prior to 48 h of life. Soap bubble meconium is typically seen in the collapsed left colon on the plain film, and the distended bowel tends to be less than that seen in atresias. The contrast enema reveals a normal or slightly dilated colon and rectum but... 

Fig. 1.30a-e. Hirschsprung disease. Supine (a), upright (b) and lateral (c) plain radiographs show distension of the bowel corresponding to a low obstruction, with air-fluid levels in the upright film and absence of gas in the rectum in the lateral film. d,e Contrast enema shows a distended colon and an obvious zone of transition (arrows) in the rectosigmoid junction. The caliber of the rectum is very small... 

Guo JZ, Ma XY, Zhou QH (1986) Results of air pressure enema reduction of intussusception 6,396 cases in 13 years. J Pediatr Surg 21 1201-1203... 

Zambuto D, Bramson RT, Blickman JG (1995) Intracolonic pressure measurements during hydrostatic and air contrast barium enema studies in children. Radiology 196 55-58... 

Plain film shows most frequently a dilated small bowel with only a few or even no fluid levels and an absence of air in the rectum. Because of air-trapping in stools, a mottled appearance can be seen in the right side of the abdomen (Fig. 5.13a,b). US will show dilated small bowel loops (ileum) fully filled with huge hypoechogenic masses (Fig. 5.13c). A contrast enema with nonionic media shows fecal impaction in upper colonic segment or higher ileum. This pro-... 

At contrast enema there may be simultaneous opacification of the true and the twin lumen. The cystic duplication may or may not contain air depending on whether it communicates with the lumen of the colon. 

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