- Purpose of
- procedure Purpose of
- procedure Purpose of
- procedure Purpose of
- procedure When the study is assigned and what it allows to see
- Recommendations for manipulation of
- How is irrigoscopy made
- Related videosAmong others, irrigoscopy of the intestine can also be prescribed. This study of the large intestine through the use of X-rays using contrast medium. It has a number of advantages, so it can be assigned first.
This study is informative, has a minimum of contraindications, is not traumatic, and the contrast medium itself has no effect on the body, since it is not absorbed into the gastrointestinal tract( GIT), in addition, irradiation with irrigoscopy is lower than with CT.What is this "irrigoscopy of the intestine" and how it will be carried out, the doctor will tell in detail.
The purpose of the procedure
The diagnosis is used to determine the diagnosis, determine the location of tumors( tumoral process, polyps, diverticulitis), assess the mucosal tissue condition, identify ulcers, atrophy sites, the features of the gut structure, and study the functional state of the organ( atony, spasms).
Barium sulphate and water-soluble iodine-based contrast agent may be used as a contrast agent( image quality below).The contrast is injected directly into the rectum( enema) or orally 12 hours before the study. How to enter the contrast depends on the diagnostic purposes.
In order to better visualize the mucous tissue of the lower intestine, contrast must be entered through an enema, rather than orally. When oral contrast is taken, barium covers the walls of not only the thick but also the small intestine, which makes it impossible to see whether the shutter is functioning between the thick and small intestines, and the walls of the organ are not stretched, hence the pictures are less informative.
With simple contrasting, a solution of barium sulfate is introduced, and with double contrasting, addition of air is carried out using Bobrov's apparatus. The air stretches the intestines, the walls of which are covered with a barium suspension, which allows for more detailed study of the relief of the mucous tissue and see the formations that remained invisible with simple contrasting.
Double contrast is informative in case of suspected
neoplasm. The advantage of an irrigoscope before colonoscopy is that the changes in the folds of the intestine that are inaccessible to the colonoscope( behind folds of the mucosa, around the bend of the colon, in the convoluted sigmoid colon) are visualized. Thanks to this, you can consider all the features of the anatomy of the colon. In addition, the method allows you to assess the location and size of the colon and its functional characteristics.
Unlike colonoscopy, the method is less traumatic and less likely to lead to complications. Irrigoscopy is not an alternative to colonoscopy, because only with the help of a colonoscope can the large intestine be studied in detail, if necessary, take the material for histological examination or remove pathological formation.
When a study is ordered and that it allows to see
Irrigoscopy is assigned to a patient who seeks a doctor with complaints:
The study also shows if there is a suspicion of a malignant neoplasm of the large intestine or acute obstruction.
- for the presence of pus, blood or mucus in the stool;
- on the pain syndrome in the anus;
- for pain in the lower abdomen;
- for the alternation of diarrhea or constipation.
In the absence of pathology, the shape and location of the intestine corresponds to the patient's age standard. The stretch and elasticity is uniform throughout the entire length of the intestine, the lumen of equal diameter( there are no sharp narrowing or adhesions), the relief of the mucous tissue without pathological protrusions or depressions, and the contrast does not penetrate above the large intestine.
If ulcers or diverticula form in the intestinal mucosa, they are filled with a contrast agent and appear as hollows in the pictures. Polyps, on the contrary, have the appearance of protrusions of similar fungi. Inflammation and infiltration can be determined by the presence of thickening of the intestinal wall.
The cancer tumor has the appearance of a rounded formation, which can be with a smooth surface or covered with erosions. If the intestine is obstructed, a certain section narrows, and the contrast material does not reach the buginia flap, which separates the small and large intestines.
With increased tonus of the organ in the image, the lumen of the intestine is markedly narrowed and the folding is increased, and when atony the lumen is enlarged and the folds are smoothed
Thus, according to the picture, the doctor can judge changes in the structure and contraction of the organ, which makes it possible to supply or clarify the diagnosis. For example, an irrigoscopy makes it possible to see:Intestinal diverticulitis
- irritable bowel syndrome( the folds of the gaustra are strongly relaxed in one place, on the contrary, they are strained, the lumen is narrowed, after the defecation the complete removal of contrast medium does not occur);
- non-ulcerative colitis( lumen in the colon of unequal diameter, which indicates uneven contraction of the muscles of the organ, there are foci of inflammation, in areas where the spasm of the fold is pronounced, the distance between them is too small);
- nonspecific ulcerative colitis( ulcers are filled with contrast, because of which the mucosa looks like a mesh or spotted, there are notable "pseudopolep" formations, part of the intestine is relaxed, and some are spasmodic);
- diverticulosis( the contrast penetrates into the diverticula( hollows the size of a millimeter to several centimeters) because of what the intestinal wall has an uneven contour, next to the inflamed diverticulum is seen the thickening of the wall due to infiltration, if there was a rupture of protrusion, the contrast flows into the abdominal cavity);
- cancer of the colon( at the initial stage, rounded with flat edges of the formation, around the tumor as a result of edema and atony the bowel relief changes, physiological folds may not be present, barium accumulations near the formation or on it speaks about the expression and disintegration of the tumor);
- presence of polyps.
Irrigoscopy is not given to pregnant women, as the patient should receive a dose of radiation, which is supposed to adversely affect the development of the fetus. Also, a study is not conducted if the patient has problems with the myocardium and coronary vessels or a high heart rate, since fear associated with the procedure can worsen the functioning of the cardiovascular system.
Irrigoscopy is contraindicated if there is a suspicion of a violation of the integrity of the intestinal wall( as a result of perforation of the ulcer, rupture of the diverticulum or disintegration of the tumor), since the contrast substance can seep into the abdominal cavity and cause a number of pathologies. At the discretion of the doctor, the study is carried out, but as a contrast, not barium sulfate, but an aqueous solution of radiocontrast substances is used.
For diverticulitis and ulcerative colitis, irrigoscopy should be carried out with extreme caution, as the organ, overflowing with air or contrast, may burst at the site of injury. In order not to provoke complications, barium suspension and air are supplied under low pressure.
Recommendations for the manipulation of
Two days before the study, a generous drink( up to 2 liters per day) and refusal of products causing gas formation or long-digesting( vegetables, fruits, milk, potatoes, buns and bread, fatty meat) is recommended.
To ensure that the large intestine does not fill up with the calves, it is necessary to refrain from eating for 18-20 hours prior to the
test. The preparation for intestinal irrigation consists of cleansing the digestive tract from stool. The remains of feces worsen the view of the mucous tissue, which can affect the informativeness and accuracy of the study, so you need to carefully follow the doctor's recommendations for the preparation for the study. Prepare the intestines for diagnosis by the following methods:
- application of pharmacy products;
- staging of enema;
- after a session of hydrocolonotherapy.
Which method is suitable in each case, the doctor will advise on preliminary consultation. The use of a laxative is recommended for patients with ulcerative colitis or diverticulitis, since they are contraindicated in enemas.
For cleansing the bowels, you need to drink 3-4 liters of water with a diluted product. One bag of Fortrans is mixed in a liter of water and drunk in several receptions. To improve the taste of the product, you can add lemon juice or other juice, but without pulp.
The first liter of liquid should be drunk about 16-17 hours, the second at 17-18 hours, and the third to 19 hours. The laxative starts to work within an hour after the first dose and it takes another 3-5 hours after the last dose. After carrying out of clearing actions it is possible to drink only juice, tea, a broth.
Laxative is contraindicated in the presence of allergies to the components of the drug, with dehydration, heart failure, perforation, or the risk of perforation of the gastrointestinal tract, the patient who has a tendency to intestinal obstruction. Also, the drug is not recommended for children under 15 years of age, since there is no information on the effect of the drug on the children's body.
The procedure is not recommended in the presence of ulcers, erosions, cracks, inflammation in the large intestine. Also, you can not do an enema if there is a tumor, hemorrhoids or prolapse of the rectum, with uterine or gastrointestinal bleeding, with constipation with severe pain in the lower abdomen. Contra-indication is the cleansing of the intestines, thus, and with heart failure.
To purify the intestine, boiled water is used at a temperature of about 36 ° C.About 1-1.5 liters of water is poured into one procedure. Two cleansing enemas are done the night before, with an interval of 3 hours and two before the irrigoscopy. The criterion of sufficient purification of the intestine is pure washing water.
This procedure is carried out in the department of proctology before the implementation of irrigoscopy. Washing of the intestine is done with the help of special equipment. The large intestine is repeatedly filled with water through a plastic tube, the liquid spreads through all the departments and comes out with the contents of the intestine through another tube.
About 20-30 liters of water are used per procedure. The pressure in the intestine does not exceed 100 millibars, which allows you to cleanse the intestines in a gentle way. The purification process is monitored on the monitor. The duration of the procedure is 25-45 minutes.
How is the
irrigoscopy performed? The study is conducted in a specially equipped X-ray room.
Duration of the study 15-45 minutes
The examination is as follows:
- the patient lies on his side, pulling the upper leg to the stomach;The
- specialist makes an enema containing a solution containing a contrast agent;
- after the intestine is filled with a solution, the radiologist takes a few shots( sighting and sighting).To visualize the necessary areas, the subject is recommended to change the position of his body;
- after all the solution is injected, the doctor releases the tube and sends the patient to emptying;
- the introduction of a contrast agent is carried out not only rectally, but also orally. In the latter case, diagnostic images are taken after several hours( the region of the caecum stains after 2.5-3 hours, the direct region - 12-13 hours);
- the final stage of diagnosis requires double contrasting - the method allows to confirm or deny the presence of polyps, neoplasms, ulcers of mucous membranes. With the help of indirect signs, radiologists diagnose the presence of tumoral processes of nearby organs.
Difficulties with defecation may occur in the examinees for several days after the manipulation. Experts advise to make an enema or prescribe a drug laxative medication. The patient may notice that his feces have found a light color. This is absolutely normal reaction to the introduction of contrast medium.
Specialists observe the patient during the first hours after diagnosis, as complications that require urgent intervention may occur. These conditions include severe dizziness, attacks of nausea and vomiting, pain syndrome, discharge of blood from the rectum.
Similar signs may indicate intestinal perforation, barium embolism, contrast in the retroperitoneal space. Irrigoscopy of the intestine is a painless examination, although some uncomfortable sensations arise when stretching the walls of the organ. Her patients suffer much more easily than a colonoscopy.