Bowel irrigoscopy: preparation asis performed when it is indicated and if there are any contraindications to itsto conduct

Update: February 2019

Irrigoscopy is a special method for examining thick
intestines using contrast radiography. The essence of the technique
consists in the introduction into the intestine of a special contrast agent, which
helps to see pathological changes and diseases in
the body.

What is the difference between irrigoscopy and irrigography?

Irrigography and irrigoscopy are fundamentally different from each other.
other in that in the first case, the X-ray irradiation is carried out by small
single doses only 4-5 times and all (this survey is carried out
mostly children, to reduce radiation exposure). And at the second
X-ray irradiation is carried out continuously by several
portions, radiation load is more, is used in adults. With
roentgenoscopy images are always taken as
documentary evidence of the pathology obtained.

Features of the study

For inspection of the intestine using high-contrast
water soluble substances of two types:

  • the first part is barium sulfate (this is the main substance),
    tannin (for better adhesion of a substance in the digestive tube),
    sodium citrate, gelatin or cellulose (to increase viscosity
    drug);
  • the second type of contrast is sodium amidotrizoat
    (Verografin or Urografin). It is a rather expensive drug, its
    use only in some cases – in newborns with
    suspected of various gastrointestinal anomalies or at any age when
    suspected perforation of the intestinal wall.

The drug is introduced into the intestine through the rectum with
contrast enema. For one study, approximately half is needed.
liter of solution. In some cases, more are inserted into the anus.
air (as a low contrast agent) for better visualization
body. Air helps to determine the thickness of the wall of the body and the folds
mucous membrane.

Double contrast is a more detailed method.
исследования состояния mucous membrane. This method is preferred for
identify local tumor recurrence or relapse in the area
postoperative anastomosis. They do not use when infested
obstruction in debilitated patients with severe
intestinal diverticulosis (prevents to look for tumors) or long
colon.

The most common technical irrigation
difficulties:

  • Poor preparation and feces in the gut making it difficult
    visualization.
  • Contrast incontinence.
  • Insufficient contrast filling of the right sections.
    intestine.
  • Perforation of the diseased rectum during filling
    by contrast.

Patients should be prescribed contrast with extreme caution.
surveys because in most cases it is impossible to predict
body reaction. The patient may experience allergic reactions.
and anaphylactic shock.

It is also very important that the decoding of the study involved
It is the radiologist who conducted the study.

When prescribed irrigoskopii when its
contraindicated?

Indications: Contraindications:
  • with excessive organ mobility
  • Meckel’s diverticulum, diverticulosis
  • dolichosigma
  • Hirschsprung disease
  • dystonia and organ dyskinesia
  • Crohn’s disease
  • tuberculosis
  • chronic colitis
  • nonspecific ulcerative colitis
  • malignant and benign tumors
  • bowel injury
  • foreign bodies
  • perforation of the wall
  • acute intestinal obstruction
  • acute period of infectious diseases
  • fever to febrile numbers (40-41 C)
  • pregnancy and lactation period
  • coma
  • acute cardiovascular failure
  • swelling of the brain

How to prepare for intestinal irrigoscopy?

Careful preparation for research is very important to her.
carrying out.

  • 2 days before the procedure, the patient is recommended to pass all tests.
    (complete blood count and urine, biochemistry).
  • After that, 2 days you need to follow a slag-free diet and eliminate
    products that increase gas formation in the intestines: black bread,
    peas, soybeans, carbonated drinks, alcohol, fried foods.
  • At lunch on the eve of the manipulation (at 12-14 hours) you need to drink
    laxative, such as Fortrans, magnesia sulphate, lactulose
    (see laxatives).
  • After 6 pm, food is stopped, no more snacks,
    dinners and breakfasts.
  • In the evening and early in the morning on the day of the study should be done
    cleansing enemas with saline (taking Fortrans not
    replaces enema).

Preparing for intestinal irrigoscopy Fortrans:

Fortrans (Macragol)

  • Fortrans 4 bags of powder 450-500 rub.
  • analogues – Lavacol 180 rub. Endofalk 450 rub, Osmogol,
    Realaxan, Forteza Rompharm, Tranzipeg, Forlax

Indications: для очищения толстой кишки перед рентгеновским,
endoscopic examination, before surgery.
Contraindications: сердечная недостаточность, дегидратация,
malignant disease of the colon with extensive damage,
intestinal obstruction, children under 15 years old. Withменение: Макрогол
intended for oral administration, dissolve 1 sachet in 1 liter
water. It takes 3-4 liters for an adult at the rate of 1 liter
solution for 15-20 kg body. The solution is required to take
once or divided into 2 doses – the first at 12-13 hours
on the eve of the procedure, the second time in the evening. Side effects: vomiting
or nausea while taking a drug that stops after
reception, bloating, allergic reactions in the form of edema,
rash

How is the examination of the intestine?

Irrigoscopy is a rather unpleasant research method, therefore
for the doctor, first of all, it is important to find the approach to the patient,
calm him down before the procedure. The doctor must explain in detail
all possible complications and unpleasant moments of the procedure.

There are three phases of the survey:

  • phase of weak filling – contrast covers the mucous
    shell, its folds are well visible;
  • tight filling phase – the intestine is completely filled
    contrast agent, which allows to estimate the diameter of the body, its
    shape, location, contours, the presence in the lumen of foreign
    bodies, identify the places of contraction and expansion of the intestine, its obstruction.
    In addition to studying the structure of the body, you can study its function:
    is there a peristalsis, how to quickly remove the contrast, elasticity
    walls;
  • double contrasting phase – enter about
    800-900 ml of air.

Irrigoscopy sequence:

  1. radiologist performs a survey of the abdominal cavity of the patient
    standing and lying down;
  2. the patient is placed on a couch on the left side. In the anus
    insert the enema tip, smeared with petroleum jelly, and pour into
    intestine barium mixture.
  3. after filling the rectum and sigmoid colon, the patient
    shift to the back, then to the right side. Barium mixture
    is introduced very slowly and accurately.
  4. the radiologist takes a series of shots with weak and tight
    filling out.
  5. then air is introduced into the rectum, it is very dosed.
  6. the doctor makes radiographs in double contrast
    (barium sulfate – air).
  7. the patient is emptying the intestines
  8. A targeted shot of the abdomen after the exit
    barium sulfate

Pathological syndromes detected using the technique:

  • bowel movement – with invagination of the intestine;
  • mucosal relief change – with chronic
    colitis;
  • expansion of the intestine (diffuse or local) – with the disease
    Hirschsprung, over the place of obstruction;
  • сужение кишки (диффузное или локальное) – при tuberculosisе,
    Crohn’s disease;
  • нарушение функции body.

Where can I do bowel irrigoscopy?

This is a very complex technique, so it’s best to contact
highly specialized clinics for its implementation. Price
survey ranges from 3 000 rubles.

What other appoint methods of examination of the intestine?

Irrigography is not the only means of studying the digestive tract. Exists
a number of techniques to identify intestinal diseases:

  • colonoscopy – prescribed for cancer, Crohn’s disease,
    ulcerative colitis; can I take a biopsy
    suspicious area;
  • radionuclide diagnosis – used in inflammation
    Mekkel’s diverticulum;
  • general abdominal radiography – reveals perforation
    body;
  • Ultrasound – used for Crohn’s disease to determine the thickness
    стенки body;
  • CT, MRI – well visualize the germination of cancer in
    adjacent organs, enlarged lymph nodes.

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