Barium Distension

There are two intravenous spasmolytics available for CT colonography hyoscine butylbromide and glucagon hydrochloride. Both produce hypotonia in smooth muscle within the colonic wall and are used widely to improve distension during double contrast barium enema. However, while both agents have been shown to improve patient perception during barium enema, only hyoscine butylbromide reliably improves distension (Goei et al. 1995 Bova et al. 1993). As a result, it is widely utilized for barium enema across Eimope (hyoscine butylbromide is not licensed for use in the USA). 

Fig. 4.5. Linitis plastica. This patient had a normal but difficult endoscopy in which distension of the stomach was problematical. He had symptoms of dyspepsia, early satiety, and weight loss, and the barium study clearly shows a linitis pattern in the fundus...

Adequate mucosal coating is achieved by the use of a high-density barium suspension. The type of harium used significantly affects the quality of the examination, as mucosal coating depends on the physical and chemical properties of the barium sulphate suspension. The best results are achieved using either high-density barium (200% wt/vol - i.e. E-Z-HD) or intermediate density (100% wt/vol) barium such as Baritop. Gaseous distension is required in order to distend normal folds and properly visualise the mucosa (Levine et al. 1988). 

Fig. 12.9a,b. Small bowel malrotation. Plain radiograph demonstrating dilated stomach and first part of the duodenum in an infant with mid-gut volvulus b barium meal confirms the enormous distension of the duodenum. Note the collapsed jejunal loops... 

Fig. 12.10a,b. Mid-gut volvulus, a Double-contrast barium meal showing distension of stomach and proximal duodenum in a young adult patient. Note the collapsed jejunal loops on the right side of the abdomen b CECT confirming mid-gut volvulus. Note twisting of the mesentery as demonstrated by the whirl sign... 

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