X-ray (radiography) of the large intestine (irrigoscopy with irrigography)

The large intestine is the final part of the digestive tract. In this section of the intestine, water is absorbed and the formation of feces, which will then be removed from the body. In addition, the large intestine is responsible for the absorption of vitamins, amino acids, glucose, and electrolytes from food. This part of the digestive tract is prone to a variety of diseases – the development of tumors, inflammatory processes, impaired absorption of nutrients and peristalsis (motor and contractile activity of muscle tissue in the intestinal walls, which contributes to the promotion of its contents). Why are such pathologies dangerous? They directly affect the general condition of a person, and some of them (to a greater extent this applies to oncology) are extremely dangerous to life and health if they are not identified and treated in time. One of the methods for diagnosing diseases of this part of the gastrointestinal tract is x-ray of the large intestine.

How does the human large intestine work, for which its examination is prescribed

The main stages of digestion associated with the primary processing and digestion of incoming food occur in the stomach and small intestine. However, after the transition of the food bolus to the section of the large intestine, the process of its processing does not end – it is the large intestine that is responsible for the further intake of the remaining useful substances into the blood from the processed food.

Anatomically, the department is represented by the blind, colon, sigmoid and rectum. The colon, in turn, has three subdivisions – ascending, transverse and descending. The rectum has a wider part – the so-called ampulla of the rectum, and a tapering section, located closer to the anus – the anus. Visually, the large intestine looks like a loop, the shape of which is similar to a square with an open contour. On average, its diameter reaches 6-6,5 centimeters, and its length is about two meters.

The large intestine contains a wide range of beneficial bacteria. This specific microbiota contributes to the further processing of the food bolus, and its transformation into fecal mass. Useful nutrients that remained in the contents of the food bolus at the stage of its presence in the thick section are processed by bacteria and converted into vitamins, sugars and amino acids. Then they are absorbed by the mucous membrane of the intestinal wall and enter the bloodstream.

The remains of undigested food accumulate in the large intestine and are expelled from the body during bowel movements.

The large intestine, as part of a well-established mechanism, performs its functions in conjunction with the rest of the digestive tract, so in a healthy person, food passes a continuous path from the oral cavity to the rectum, through which the unprocessed mass is excreted.

With pathological changes in the large intestine, the patient complains of characteristic symptoms, deterioration of health, weight loss, abdominal pain and other ailments. In such cases, it is necessary to prescribe diagnostic procedures, in particular, X-rays of the large intestine.

What diseases can affect the large intestine

Most often, in patients with problems in the work of the large intestine, they find:

• ulcerative colitis;
• colon cancer and polyps;
• Crohn’s disease;
• ischemic and pseudomembranous colitis;
• irritable bowel syndrome;
• wall diverticula;
• congenital anomalies.

Ulcerative colitis

Pathology is a chronic condition of an organ, when its internal mucous membrane becomes edematous, inflamed, changes its color from normal beige-pink to bright red, its integrity is violated due to small ulcerative formations. These ulcers do not heal well and bleed. A disease with a long course and without adequate treatment can provoke the appearance of polyps and neoplasms.

Polyps, neoplasms

Tumors in the large intestine are quite common in patients. In the last decade in Europe and the United States, colon cancer (colorectal cancer) has taken the first place among malignant tumors of the digestive tract, which accounts for more than half of all cases of digestive cancer. Due to the aging of the world’s population, the situation is expected to worsen in the future. Colon cancer is a dangerous disease that requires serious complex treatment. Polyps and tumors in this part of the body are more dangerous because their development is almost asymptomatic, and in the early stages they can only be detected by accident.

Crohn’s disease

The disease is characterized by a general inflammatory process in the digestive tract, which covers the inner lining of the walls, as well as the middle and outer, as well as the adjacent lymphatic vessels of the intestine. The disease is difficult to diagnose, since its symptoms are similar to a dozen other pathologies, and its complications are extra-intestinal in nature – damage to large joints, the appearance of ulcers in the oral cavity, vision problems.

Ischemic and pseudomembranous colitis

In ischemic colitis, the degenerative process affects the vascular system that feeds the intestinal walls. Ischemia is accompanied by local inflammation and ulceration of the mucous layer of the wall, the gradual development of intestinal obstruction.

Pseudomembranous colitis develops due to the significant multiplication of one of the varieties of intestinal bacteria – clostridia. Normally, the gut microbiome is self-regulating, with each bacterial species controlling the growth and development of all the others. With prolonged use of antibiotics, laxatives or cytostatics, some bacterial species are destroyed, and, accordingly, the reproduction of others is increased.

Clostridia in the course of their life activity produce toxins that negatively affect the lining of the intestine, which is why fibrous plaques called pseudomembranes form on them.

Irritable bowel syndrome

The main cause of IBS is considered to be a violation of intestinal motility, however, the disease can also be secondary, that is, it can occur against the background of other diseases of the gastrointestinal tract. In the intestines, discomfort is constantly felt, the localization and symptoms of which are quite difficult to determine accurately.

Diverticula and diverticulitis

Diverticula in the walls of the large intestine look like sacs. In fact, they represent a stretching of the wall, in which a “pocket” is formed, protruding towards the abdominal cavity. The course of the process without complications can, in the worst case, cause constipation or a feeling of heaviness in the abdomen. However, if the contents of the intestine stagnate in the cavity, against the background of the presence of dysbacteriosis in the intestine, diverticulitis may develop – an acute inflammation with characteristic, dangerous symptoms.

Congenital structural disorders

Such disorders include elongation of the sigmoid colon (dolichosigma), as well as hypertrophy of the colon in any of the departments, or in a specific segment. Pathologies are characterized by disorders of intestinal processes, constipation, flatulence. In severe cases, intoxication with stagnant feces may develop.

Radiography of the large intestine: irrigoscopy and irrigography

X-ray examination of the intestine is widely used as a method for diagnosing its condition. Since the organ under study is hollow, the procedure carried out can be informative only with the use of a contrast agent.

Performing the irrigography procedure involves fixing the image obtained during X-ray irradiation on a special film, while during irrigoscopy, the image is displayed on the monitor screen and a colon examination in real time. There are no differences in terms of technique or methods of preparation.

Irrigoscopy itself can be of two types – it depends on the method of contrasting:

• classical barium enema involves the introduction of a contrast agent in a liquid state;
• irrigoscopy with double contrast: in this case, the patient is first injected with a liquid contrast that envelops the walls of the intestine, after which gas or air is gradually supplied into the intestinal cavity.

Indications and contraindications for irrigoscopy

The list of reasons why a doctor may send a patient for examination of the condition of the large intestine includes characteristic pathologies that affect this section of the gastrointestinal tract. Patients usually come to the doctor with typical symptoms:

• violation of the stool (disorder or constipation, if they are of a long-term nature);
• flatulence;
• bleeding from the anus;
• pain, feeling of heaviness in the abdomen;
• the presence of blood in the stool.

However, the symptoms themselves are not the basis for the appointment of barium enema. The doctor conducts a survey and examination of the patient, prescribes the necessary tests and ultrasound of the abdominal organs. Based on the results obtained, a decision is made on the need for contrast radiography of the large intestine.

The indication for the appointment of the procedure, most often, is the suspicion of the presence of a pathology or condition, if the results of preliminary analyzes and examinations do not allow to accurately establish the diagnosis and determine the etiology of the process. The doctor refers the patient for x-rays, suspecting:

• the presence of tumors and polyps;
• gastric and intestinal bleeding with a tendency to relapse;
• Crohn’s disease;
• intestinal obstruction of any nature;
• diverticulitis;
• dolichosigma;
• Hirschsprung’s disease (congenital anomaly);
• the presence of foreign bodies;
• ulcerative, ischemic, pseudomembranous colitis;
• various inflammatory processes in the intestines.

Pain syndromes in the anus, anus, abdominal cavity, excessive organ mobility, prolonged and painful constipation, and systematic bowel disorder are also indications for irrigography.

When should a patient not be given a procedure? Doctors name among the contraindications of irrigography such factors:

• rapidly progressive ulcerative colitis;
• the presence of pregnancy;
• toxic megacolon;
• colitis with severe course;
• the presence of allergies or intolerance to the contrast agent;
• cardiovascular diseases, hypertension;
• early postoperative period, if the intervention took place in the abdominal cavity.

How to prepare for a colon x-ray

The procedure requires special preparation to obtain diagnostically significant results, which are affected by the presence of feces in the intestine, when the contrast agent cannot be fully distributed throughout the organ.

Therefore, before the procedure, the patient must take care of cleansing the large intestine.

Preparation includes adherence to dietary restrictions, mechanical and medical cleansing measures. Two to three days before the scheduled date of the X-ray, it is forbidden to use:

• raw vegetables: beets, carrots, cabbage;
• millet, pearl barley and oatmeal;
• apples;
• apricots;
• black bread;
• peas and other legumes;
• alcohol and carbonated drinks;
• fried or grilled foods.

On the eve of the procedure, before going to bed, you should do a cleansing enema and take a laxative recommended by your doctor. Be sure to do an enema in the morning on the day of the procedure.

Irrigoscopy for adults and children: technique

The diagnostic procedure can be carried out only in the conditions of a medical institution, in some cases – with the placement of the patient in a hospital. The doctor makes every effort to ensure that the examination is carried out as quickly and safely as possible for the patient.

Initially, the radiologist needs to take several survey pictures, while the patient should alternately take a prone and standing position.

The patient is placed on the couch in the position on the left side. Through the anus and rectum, with the help of a special contrast enema, he is injected with a contrast agent.

For this purpose, two types of contrast agents are used:

• a preparation with barium, in which the main substance is barium sulfate, and the auxiliary substances are tannin, sodium citrate, gelatin or cellulose;
• sodium amidotrizoate is part of Urographin or Verographin.

The second type of drugs is mainly used to examine newborns, or for patients of any age with suspected perforation of the intestinal wall.

The procedure is carried out in several phases. First, the phase of weak filling, when the contrast gradually envelops all the folds of the mucosa, visualizing them well. This is followed by a phase of tight filling – during which the intestine is completely filled with contrast, which makes it possible to assess the thickness of the lumen, shape, location, contours, the presence of foreign bodies, places of narrowing and expansion. By how quickly the contrast is excreted by the intestines, the doctor can draw conclusions about the elasticity of the walls and intestinal motility.

For research, you will need about 500 milliliters of solution. If you have a double contrast procedure, you will need a little less fluid. Gas or air is introduced into the cavity for a clearer visualization of the thickness of the walls and folds of the mucous membrane, and the organ as a whole. This procedure is called the double contrast phase.

After the injection of the substance, when the rectum and sigmoid colon are filled with contrast, the patient is transferred to the back, and then to the right side, and a series of images is taken at different filling phases. Further, if necessary, air is introduced into the intestine and a number of images are taken, already with double contrasting.

The patient then empties the bowel and after all the contrast has left the bowel, the doctor takes a final x-ray of the abdomen without contrast.

The irrigoscopy procedure for children is no different from that for adult patients. Children, if possible, try to prescribe alternative methods of examination, since preparation requires considerable time and effort, and the procedure itself is not pleasant, although it is painless. Children of primary school age may be prescribed irrigography under general anesthesia.

When performing irrigography in a patient, some difficulties are possible. With poor preparation, there may be feces in the intestines, visible in the pictures. If the sphincter is weak, the patient will experience contrast incontinence. In addition, the contrast agent can be unevenly distributed throughout the large intestine, which makes it difficult to analyze the obtained images.

The danger for the patient is the situation of perforation of the pathologically altered intestinal wall due to the introduction of contrast. In each case, the radiologist decides whether or not to carry out the procedure further. If necessary, the doctor stops the examination at any stage and proceeds to provide emergency medical care to the subject.

Possible risks and consequences of the procedure

Clinicians consider barium enema to be a safe examination method. Provided that all preparation requirements are met, if the doctor has a sufficient level of qualification, usually the patient does not have any problems after an X-ray of the large intestine with contrast. However, there are exceptions, for example, when perforation of the altered intestinal wall due to the injected contrast, or when the contrast agent enters the abdominal cavity.

In some cases, the subject after diagnosis feels weakness, drowsiness and dizziness. These symptoms are not dangerous and pass quickly.

If, after the procedure, the patient systematically notices an increase in body temperature, intestinal disorders, blood coming out of the anus, nausea, vomiting and abdominal pain, it is necessary to visit the attending physician.

Examination of the large intestine using barium preparations and X-ray irradiation is a reliable way to detect diverticulosis, rectal cancer, dolichosigma, the presence of foreign bodies, other pathologies and diseases, and functional disorders. In addition to the fact that, based on the results of irrigoscopy, the doctor can make a primary or confirm an existing diagnosis, the procedure also allows you to verify the grounds for surgical intervention.