Contrast enema of the colon (synonyms: contrast enema (KE), colon contrast enema, colon contrast enema, colon contrast enema, colon contrast enema, colon CE, colon CE) is a radiographic method for imaging the colon (large intestine). It is used, among other things, for the diagnosis of tumorous and inflammatory diseases. Today, the examination is largely superseded in clinical practice by colonoscopy (colonoscopy), as well as by other imaging methods – computed tomography (CT), virtual colonoscopy; magnetic resonance imaging (MRI). Nevertheless, colon contrast enema offers some decisive advantages: Particularly severely inflamed bowel segments, highly stenosed (narrowed) areas, or tortuous loops of bowel often cannot be adequately viewed or negotiated with the endoscope, so the colon contrast enema must be used.
Indications (areas of application)
- Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum).
- Diarrhea (diarrhea) of unknown etiology.
- Diverticulosis and diverticulitis – diverticula are sac-like protrusions of the small intestine wall; if the diverticula are numerous, it is diverticulosis and if the diverticula are inflamed, it is diverticulitis
- Enteritis (inflammation of the digestive tract) of unclear genesis.
- Fistulas – as a result of inflammation, these can form in the connection between two hollow organs or intestinal loops.
- Ischemic colitis – inflammation of the large intestine with tissue undercuts.
- Control before repositioning of an anus praeter (artificial anus).
- Positional anomalies of the colon
- Hirschsprung’s disease (synonym: megacolon congenitum) – disease of the colon belonging to the group of aganglionoses. A deficiency of ganglion cells (“aganglionosis”) in the area of the submucosal plexus or myenteric plexus (Auerbach’s plexus) leads to hyperplasia of the upstream nerve cells, resulting in increased acetylcholine release. Due to the permanent stimulation of the ring muscles, it thus comes to a permanent contraction of the affected section of the intestine.
- Crohn’s disease – chronic inflammatory bowel disease.
- Constipation (constipation) of unclear genesis.
- Postoperative stenosis (narrowing) and adhesions (adhesions) of the colon (large intestine).
- Polyps – 70-80% of all colorectal polyps are adenomas, which are neoplasms (new formations) that carry malignant potency, that is, they can degenerate malignantly.
- Radiation enteritis – radiation-induced intestinal disease, which in some cases occurs immediately after X-ray irradiation as a result of exposure to radiation and leads to damage to the rapidly dividing mucosal cells.
- Tuberculosis (consumption) – bacterial infection with Mycobacterium tuberculosis.
- Tumors – e.g. colon carcinoma (colon cancer).
The procedure
In order not to jeopardize the success of contrast imaging of the colon, extensive preparation of the patient the day before the examination is essential. This aims to clean the colon and includes the following measures:
- Food restriction
- Generous fluid intake
- Complete drug colon emptying
Before the actual contrast examination, the patient’s anus (anus) is thoroughly palpated digitally (with the fingers) to detect any pathological changes in the anal canal that might otherwise be missed. A Vaseline-covered probe is then inserted rectally with gentle twisting motions. The probe is advanced about 5 cm and the contrast medium (barium sulfate) is injected into the rectum so that it fills to bulging point. In order for the contrast medium column to completely fill the colon, the patient’s position can be changed. The whole process is documented by fluoroscopy. For double contrast imaging of the colon, a further step is performed: after the patient has largely excreted the contrast medium, the colon is expanded with air, which is also followed by fluoroscopy. Colon contrast enema should not be performed in the presence of an acute abdomen with signs of diffuse peritonitis (inflammation of the peritoneum), perforation (intestinal rupture), toxic megacolon (massive, life-threatening distension of the colon), circulatory disturbances of the bowel, or biopsies performed less than 7 days previously.
