Enteric contrast media

• It is a contrast agent such as barium sulfate

& diatrizoate sodium-meglumine
(Gastrografin) that are deemed safe for use
in the gastrointestinal tract only.
• It may be administered orally or rectally.
• It is used to visualize any abnormalities in
the gastrointestinal tract.
 BARIUM SULPHATE
• Barium suspension is made from pure barium sulphate
which is heavy soluble material made from barite
• It is high atomic number materials that strongly absorb
X-rays and are therefore seen as dense white on
radiography
• The particles of barium must be small (0.1-3 μm), since
this makes them more stable in suspension
• A non-ionic suspension medium is used, for otherwise
the barium particles would aggregate into clumps. The
resulting solution has a pH of 5.3, which makes it
stable in gastric acid.
• There are many varieties of barium suspensions in use
but most situations the preparation may be diluted
with water to give a lower density
TYPES OF BARIUM CONTRAST IMAGING

Barium • pharynx and esophagus

swallow
• Lower esophagus, stomach and
Barium meal duodenum

Barium follow • Small intestine

through

Barium enema • large intestine and rectum

Barium swallow Barium meal Barium follow
through
 INDICATION

• Dysphagia
• Upper abdominal mass
• Weight loss
• Gastrointestinal Hemorrhage
• Partial Obstruction
• Assessment of perforation
ADVANTAGE & DISADVANTAGE

ADVANTAGE DISADVANTAGE

• Excellent coating. • Taste

• Low cost • High morbidity
• Widely available associated with barium
in the peritoneal cavity.
• Subsequent abdominal
CT and US are
rendered difficult to
interpret.
• Constipation &
abdominal pain
CONTRAINDICATION & COMPLICATIONS
• Contraindication
– Suspected of perforation
– Allergy to barium or its component

• Complication
– Barium peritonitis : The escape of barium into the
peritoneal cavity is extremely serious, and will
produce pain and severe hypovolemic shock
– Aspiration : pneumonitis and granuloma formation
– Intravasation : barium pulmonary embolus
BARIUM MEAL
 indication
• Dyspepsia
• Weight loss
• Upper abdominal mass
• Gastrointestinal haemorrhage (or unexplained
iron-deficiency anaemia)
• Partial obstruction
 complication
• Leakage of barium from an unsuspected
perforation.
• Aspiration of stomach contents due to the
Buscopan.
• Conversion of a partial large bowel obstruction
into a complete obstruction by the impaction of
barium.
• Barium appendicitis, if barium impacts in the
appendix.
• Side-effects of the pharmacological agents used
BARIUM SWALLOW
 indication
• Non-cardiac causes of chest pain
• Symptomatic or suspected gastroesophageal
reflux
• Esophageal spasm or tumor
• Suspected tear following an endoscopic dilatation
• Relevant History
- Hiatal hernia
- GERD
- Pain
- Difficulty swallowing
- Trauma (injury, previous radiation treatment)
 BARIUM FOLLOW THROUGH
• Indication : Pain, Diarrhoea,
Anaemia/gastrointestinal bleeding, Partial
obstruction, Malabsorption, Abdominal mass
• Contraindication Complete obstruction 2.
Suspected perforation (unless a water-soluble
contrast medium is used).
BARIUM ENEMA
 Indication & contraindication
• Indication : Change in bowel habit , Pain , Mass ,
Melaena/anaemia, Obstruction

• Absolute Contraindication
1. Toxic megacolon
2. Pseudomembranous colitis
3. Rectal biopsy via: a. rigid endoscope within previous 5 days or
flexible endoscope within previous 24 h.

• Relative Absolute Contraindication

1. Incomplete bowel preparation
2. Recent barium meal - it is advised to wait for 7-10 days
3. Patient frailty.
 GASTROGRAFIN
GASTOGRAFFIN

• Mixture of sodium amidotrizoate and

meglumine amidotrizoate
• A iodinated contrast agent
• In perforation →reabsorbed back into the
vascular system → excreted by the kidneys
 Indication

Suspected
Meconium ileus
perforation

To distinguish
bowel from other
structures on CT
CONTRAINDICATION & COMPLICATIONS
• Contraindication
– Hyperthyroidism
– Pregnancy and lactation
– Patients with fluid and electrolyte imbalances

• Complication
– Pulmonary oedema if aspirated
– Allergic reactions - due to absorbed contrast
media
 REFERENCE
• A Guide to Radiological Procedures by Stephen Chapman
& Richard Nakielny , FOURTH EDITION
• http://www.radiologyinfo.org/en/info.cfm?pg=safety-
contrast
• Diagnostic Imaging (7th edition), Rockall, Andrea, hatrick
Andrew, Amstrong, Peter, Wastie
• A guide to Radiological Procedure (4th edition), Stephen
Chapman, Richard Nakielny
• Imaging for Students © 2012 David A Lisle, Hodder
Arnold