Page 32 - Radiology Book

single contrast barium enema (scbe)
1. Low density barium or gastrogra n; check order!
2. Start patient lateral then supine.
3. Begin lling, obtain AP and LAT rectum.
4. Supine LPO rectosigmoid, if sigmoid redundant may need
additional RPO images.
5. Supine RPO splenic exure.
6. Supine LPO hepatic exure
7. Supine LPO cecum with compression.
8. Supine cecum with compression.
Use compression on all areas to survey for polyps, move air
bubbles and stool.
J PoucHogram
Another surgical procedure we occasionally see (usually in the outpatient setting) is the total proctocolectomy with ileal pouch and ileo-anal anastomosis (J-pouch) after total proctocolectomy for ulcerative colitis or familial polyposis. These patients undergo radiologic evaluation of the J-pouch before the diverting ileostomy is closed, approximately 8 weeks after the initial surgery. You are evaluating for contrast extravasation, stenosis of the pouch, or obstruction proximally. Two important pitfalls to avoid:
• NEVER perform a rectal examination on these patients!
• DO NOT use the standard rectal tube! The anastomosis at the anus is usually stenotic, and if not handled appropriately, can be torn with
the nger. (The anastomosis will be gently dilated under anesthesia at a later time).
1. Insert pediatric rectal tip gently into the pouch via the anus.
2. Obtain a digital scout lm.
3. Fill pouch until contrast re uxes out the right lower quadrant
ileostomy.
4. Obtain the following digital images centered over the pouch:
supine, both obliques. lateral, supine center over proximal ileum, including the ostomy.
Southfield16
GI Protocol