Barium-Enema Examination with Large-Bore Tubing and Drainage

Truly efficient suction devices are an aid to better, more precise radiological examinations of the colon and rectum, and at the same time give less discomfort to older and handicapped patients. The following findings reported by Templeton and Addington (1) on the use of suction have been confirmed by the author: 1. The flow of barium could be stopped at any point by drainage, and overlapping loops of colon could be examined before the interference of filling. 2. Palpation could be made easier by drainage, since the release of pressure causes relaxation of the abdominal wall, which some patients tense in attempting to retain the enema. 3. Air-contrast examination of any particular point could be made before it was obscured. 4. Selective examination of the cecum could be performed more effectively because the sigmoid colon may be collapsed. 5. The plugging of the discharge tubing by feces was the main difficulty encountered. In addition, the present author found that the usual small holes in the enema tip frequently became occluded by rectal mucosa. The current investigation was undertaken to determine whether (a) more forceful suction, (b) larger internal diameter discharge tubing, (c) thicker-walled and less collapsible tubing, (d) larger enema tips with different size and design of openings, or (e) any combination of these factors would improve upon previous technics. Tubings with an internal diameter ranging from 1∕4 to 1∕2 in. were tested both in the laboratory and on patients. The flow rate varied enormously with different barium suspensions, tubing sizes, and enema tips. With 6 feet of tubing and the enema can held 3 feet above the table top, the usual glass, plastic, and metal enema tips and connectors constricted the lumen of the tubing and hindered the flow and discharge of barium suspensions. Various-size rapid-change “bayonette-type” enema tubing connectors and tips were made that would not cause constricting or stenotic areas in the tubing. Thin-wall tubing collapsed easily and retarded the flow and drainage of barium suspensions. A rubber tubing wall thickness of 3∕32 or 1∕8 in. was found satisfactory. With 2 quarts 20 per cent (weight∕volume) constantly agitated U.S.P. barium only and a “Carman” tip, flow rates varied from 53 seconds with 1∕4-in. internal diameter tubing to 24 seconds for 3∕8-in. internal diameter tubing and 18;8 seconds for 1∕2-in. internal diameter tubing. To discharge two quarts of 40 per cent barium suspension, flow rates varied from 90.4 seconds for 1∕4-in. tubing to 29 seconds for 3∕8-in. tubing to 20.6 seconds for 1∕2-in. tubing (Table I).