Enema for low obstruction in premature infant done portably

  • Patient preparation: none
  • Contrast used: high osmolar water soluble, dilute contrast using 1 part contrast : 2 parts sodium chloride if < 1 year old or 2 parts tap water if > 1 year old
  • Technique: 8 French red rubber catheter with its tip high in the sigmoid colon, tape tip in securely, pinch buttocks firmly while injecting contrast to get a good seal (perhaps by pressing the hips together), use gentle hand injection to instill 5-10 cc contrast in supine position, consider injecting another 5-10 cc of contrast in order to opacify the entire colon with contrast and reflux the terminal ileum extensively, you know you have succeeded when you have refluxed contrast into the dilated loops of small bowel that are above the inspissated meconium
  • Images to obtain: scout AP abdomen, AP and lateral abdomen after initial 5-10 cc of contrast, AP and lateral abdomen after additional 5-10 cc of contrast if needed
  • Looking for: meconium obstruction of prematurity (most commonly)
  • Post procedure tasks: monitor for passage of meconium, if there is not significant passage of meconium / reduction in abdominal distension, consider repeating the exam