Enema for reduction of distal intestinal obstruction syndrome

  • 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, use at least 360 cc contrast diluted with 720 cc tap water (1,000 cc total), usually use 2,000 cc total in teenager
  • Technique: place tip in rectum and start contrast, turn patient to left lateral, then LPO, then supine, then RPO, then prone, need to opacify the entire colon with contrast and reflux the terminal ileum
  • Images to obtain: AP overhead after terminal ileum refluxed, post evacuation AP overhead
  • Looking for: strictures in colon, need to reflux contrast into the dilated loops of ileum above the inspissated stool in the terminal ileum in order to have the best chance to clean out the stool
  • Post procedure tasks: after exam have patient evacuate, obtain post evacuation AP overhead image to assess result, enema may have to be repeated several times over several days to completely relieve the obstruction