Irrigoscopy of the intestine: preparation, how is it done, when is it shown and whether there are contraindications to its conduct

Irrigoscopy is a special method for studying the large intestine using contrast radiography. The essence of the technique consists in introducing a special contrast agent into the intestine, which helps to see pathological changes and diseases in the organ.

What is the difference between irrigoscopy and irrigography?

Irrigography and irrigoscopy differ in principle from each other in that in the first case, x-ray irradiation is carried out in small single doses only 4-5 times and all (this examination is carried out mainly for children, to reduce the radiation load). And in the second study, x-ray irradiation is carried out continuously in several batches, radial loads are greater, used in adults. When carrying out fluoroscopy, pictures are always taken, as a documentary confirmation of the pathology obtained.

Features of the study

For inspection of the intestine, high-contrast water-soluble substances of two types are used:

  • the composition of the first includes barium sulfate (this basic substance), tannin (for better adhesion of the substance in the digestive tube), sodium citrate, gelatin or cellulose (to increase the viscosity of the drug);
  • the second type of contrast is sodium amidotrizoate (Verografine or Urografine). This is a fairly expensive drug, it is used only in some cases - in newborns with suspected various anomalies of the gastrointestinal tract or at any age if there is a suspected perforation of the intestinal wall.

The medicine is injected into the intestine through the rectum with the aid of a contrast enema. For one study, about half a liter of solution is needed. In some cases, air is also introduced into the anus (as a low-contrast substance) for better visualization of the organ. Air helps determine the thickness of the wall of the body and the folds of the mucosa.

Double contrasting is a method of more detailed examination of the mucosa. This method is preferred for the detection of local tumor relapses or relapses in the area of ​​post-operative anastomosis. They are not used in cases of weak obstruction, in weakened patients, with a pronounced diverticulosis of the intestine (prevents the search for a tumor) or a long colon.

The most common technical difficulties with irrigation are:

  • Poor preparation and remnants of feces in the gut, making it difficult to visualize.
  • Patient's incontinence.
  • Inadequate contrast filling of the right intestine.
  • Perforation of pathologically altered rectum when filled with contrast.

It is necessary with special caution to assign contrast examinations to patients, because in most cases it is impossible to predict the reaction of the body. The patient may experience allergic reactions and anaphylactic shock.

It is also very important that the deciphering of the study involved exactly the doctor-radiologist, who conducted the study.

When are they prescribed irrigoscopy, when is it contraindicated?

Indications: Contraindications:
  • with excessive organ mobility
  • diverticulum of Meckel, diverticulosis
  • dolichosigma
  • Hirschsprung's disease
  • dystonia and dyskinesia
  • Crohn's disease
  • tuberculosis
  • chronic colitis
  • nonspecific ulcerative colitis
  • malignant and benign tumors
  • intestinal injuries
  • foreign bodies
  • perforation of the wall
  • acute intestinal obstruction
  • acute period of infectious diseases
  • fever to febrile numbers (40-41 C)
  • pregnancy and lactation period
  • coma
  • acute cardiovascular failure
  • cerebral edema

How to prepare for an intestinal irrigoscopy?

Careful preparation for the study is very important for its conduct.

  • For 2 days before the procedure, the patient is recommended to pass all tests (a general analysis of blood and urine, biochemistry).
  • After this, you should observe a slag-free diet for 2 days and exclude products that enhance gas formation in the intestine: black bread, peas, soy, carbonated drinks, alcohol, fried foods.
  • On the eve of the manipulation (at 12-14 o'clock) one should drink a laxative, for example Fortrans, sulphate magnesia, lactulose (see laxatives ).
  • After 6 pm, meals stop, no more snacks, dinners and breakfasts.
  • In the evening and early in the morning on the day of the study, it is necessary to make cleansing enemas with a physiological solution (taking fortrans does not replace the enema).

Preparation for Irrigoscopy of the Intestine by Fortrans:

Fortrans (Macragol)

  • Fortrans 4 bags with powder 450-500rub.
  • Analogues - Lavakol 180 rub. Endofalk 450 rub, Osmogol, Realaxan, Fortez Rompharm, Transipeg, Forlax

: для очищения толстой кишки перед рентгеновским, эндоскопическим исследованием, перед оперативным вмешательством. Indication : for colon cleansing before x-ray, endoscopic examination, before surgery.
сердечная недостаточность, дегидратация, злокачественное заболевание толстой кишки с обширным поражением, кишечная непроходимость, детям до 15 лет. Contraindications: heart failure, dehydration, malignant colon disease with extensive lesion, intestinal obstruction, children under 15 years.
: Макрогол предназначен для приема внутрь, 1 пакетик растворить в 1 литре воды. Application : Macrogol is intended for oral administration, 1 packet is dissolved in 1 liter of water. It takes 3-4 liters for an adult at a rate of 1 liter of solution per 15-20 kg of body weight. The solution is required to be taken once or divided into 2 doses - the first one at 12-13 hours before the procedure, the second time in the evening.
: рвота или тошнота во время приема препарат, которая прекращается после приема, вздутие живота, аллергические реакции в виде отека, сыпи. Side effects : vomiting or nausea while taking the drug, which stops after taking, bloating, allergic reactions in the form of swelling, rash.

How is the examination of the intestine?

Irrigoscopy is a rather unpleasant method of research, therefore it is important for the doctor, first of all, to find an approach to the patient, to calm him before the procedure. The doctor is obliged to explain in detail all possible complications and unpleasant moments of the procedure.

There are three phases of the survey:

  • – контраст обмазывает слизистую оболочку, хорошо видны ее складки; phase of weak filling - contrast smears the mucous membrane, its folds are clearly visible;
  • – кишечник полностью заполняется контрастным веществом, что позволяет оценить диаметр органа, его форму, месторасположение, контуры, наличие в просвете инородных тел, выявить места сужения и расширения кишки, ее непроходимость. the phase of tight filling - the intestine is completely filled with contrast medium, which allows to estimate the diameter of the organ, its shape, location, contours, the presence of foreign bodies in the lumen, to reveal the sites of constriction and expansion of the intestine, its obstruction. In addition to investigating the structure of the organ, one can also study its function: is there a peristalsis, how quickly to remove the contrast, the elasticity of the walls;
  • – в кишечник вводят около 800-900 мл воздуха. phase of double contrasting - about 800-900 ml of air is injected into the intestine.

Irrigoscopic sequence:

  1. the radiologist performs a survey of the abdominal cavity of the patient in a standing and lying position;
  2. The patient is placed on the couch on his left side. In the anus, insert an enema tip, lubricated with petroleum jelly, and pour into the intestine barium mixture.
  3. after filling the rectum and sigmoid colon, the patient is shifted to the back, then to the right side. The barium mixture is introduced very slowly and gently.
  4. The radiologist makes a series of pictures with weak and tight filling.
  5. then the air is introduced into the rectum, very dosed.
  6. the doctor makes x-rays in conditions of double contrasting (barium sulfate-air).
  7. the patient empties the intestine
  8. the aim image of the abdominal cavity after the release of barium sulfate

Pathological syndromes revealed using the technique:

  • bowel displacement - with intussusception of the intestine;
  • change in the relief of the mucosa - with chronic colitis;
  • expansion of the intestine (diffuse or local) - with Hirschsprung disease, over the site of obstruction;
  • narrowing of the intestine (diffuse or local) - with tuberculosis, Crohn's disease;
  • impaired function of the body.

Where can I make an irrigoscopy of the intestine?

This is a very complicated technique, so it is better to go to highly specialized clinics to carry it out. The price of the survey varies between 3,000 rubles.

What other methods of examination of the intestine?

Irrigography is not the only means of studying the gastrointestinal tract. There are a number of techniques to detect bowel diseases:

  • colonoscopy - prescribed for cancer, Crohn's disease, ulcerative colitis; you can take a biopsy of the suspicious site;
  • radionuclide diagnosis - used for inflammation of the diverticulum of Meckel;
  • survey radiography of the abdominal cavity - reveals perforation of the organ;
  • Ultrasound - used in Crohn's disease to determine the thickness of the wall of the organ;
  • CT, MRI - well visualize the germination of a cancerous tumor in neighboring organs, enlarged lymph nodes.

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