This website translates English to other languages using an automated tool. We cannot guarantee the accuracy of the translated text. Your doctor has requested a procedure called a barium enema. This exam is performed to assess a change in bowel habits, abdominal pain or rectal bleeding, or if your doctor suspects that you may have diverticulitis small inflamed areas in your colon or polyps growth of tissue on your colon. At the S.
This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon, the sigmoid colon and the rectum. The patient was afebrile temperature Prevalence Enema expulsion picture adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. You can take your usual prescribed oral medications with limited amounts of water. Obstructions and polyps growths Cancer Unusual expuldion or lower abdominal pain Unexplained weight loss Irritable Enema expulsion picture syndrome Changes expulsipn bowel movements.
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Colorectal polyps are growths that form on the epithelium of the colon and rectum. While their prevalence varies considerably from region to region, they are common in adults. Approximately two-thirds of all colorectal polyps are adenomatous precancerous lesions that have the potential to become malignant. Usually, they are discovered and resected during colonoscopy. The spontaneous expulsion per rectum of a colorectal polyp is exceedingly rare. Here, we report a rare and unusual case that we believe is the first of spontaneous expulsion of an adenomatous polyp during defecation.
These patients should undergo colonoscopy to search for additional polyps as well as other gastrointestinal pathology. The development of colorectal polyps, particularly adenomatous polyps, is associated with several risk factors, including age i. Many colorectal polyps are benign and include inflammatory polyps, hamartomatous polyps, and hyperplastic polyps. The other major type of polyp found, and of much greater significance due to its malignant potential, is the neoplastic adenoma.
Adenomatous polyps have some degree of cytologic dysplasia and are recognized as precursors of colorectal cancer CRC. They are estimated to be present in a quarter to a third of all adults [ 7 ]. Recently, several types of serrated polyps have been implicated in the development of CRC, as well [ 16 , 17 ]. Polypectomy during colonoscopy has been demonstrated to be significantly effective in reducing the incidence of CRC [ 18 ].
However, the spontaneous expulsion per rectum of a polyp is rare. A year-old man, with past medical history of hypertension, diabetes mellitus, schizophrenia, and chronic constipation, visited his gastroenterologist with complaints of worsening lower abdominal pain and constipation for several weeks, not relieved with stool softeners and laxatives. The pain had been increasing in intensity, especially over the last 3 days. He was taking stool softeners, an over-the-counter colon cleanser, and magnesium citrate for his chronic constipation.
Attributing the worsening abdominal pain to constipation, he consumed a higher dose of magnesium citrate. Subsequently, his abdominal pain improved, but he became concerned, collected the specimen in a container, and decided to visit his gastroenterologist. He had never experienced blood in the stool or black stools before. He denied any recent symptoms of fevers, chills, nausea, vomiting, diarrhea, change in appetite, or weight loss. He reported no family history of gastrointestinal malignancy.
Previously, he had refused to undergo screening colonoscopy and to be screened with any of the other CRC screening modalities. The patient was afebrile temperature On physical exam, the abdomen was soft and not distended. There was mild tenderness at the left lower quadrant and normoactive bowel sounds.
There was no rebound tenderness, guarding, rigidity, nor organomegaly. The specimen he collected appeared to be a polyp, and it was submitted to a laboratory for histopathologic evaluation. Macroscopic examination of the specimen brought by the patient in a container after spontaneous expulsion per rectum showed a tan polypoid lesion, roughly 1. The specimen brought by the patient in a container after spontaneous expulsion per rectum. It appeared to be a colorectal polyp, roughly 1.
The specimen was later reported as tubular adenoma Fig. Histopathologic image of the colorectal polyp. The neoplastic glands are lined by hyperchromatic glandular epithelium.
The elongated nuclei and reduced cytoplasmic mucin production are consistent with a large tubular adenoma. Low-power magnification. Colonoscopy was performed and revealed multiple polyps: a 1. All of the polyps were removed with snare cautery polypectomy and submitted to a laboratory for histopathologic evaluation.
They were later reported as tubular adenoma, except for the ascending colon polyp which was reported as tubulovillous adenoma. Endoscopic images of a a 1. His chronic constipation has improved since then with a polyethylene glycol laxative. Colorectal polyps, growths protruding into the colorectal lumen above the surrounding mucosa, can be neoplastic or benign. Neoplastic adenomas are precancerous lesions that have the potential to become malignant.
Such progression to adenocarcinoma is believed to occur over a period of roughly 10 years. Therefore, with appropriate screening and surveillance, these polyps can be removed to prevent the development of cancer [ 19 , 20 ]. Although there are various CRC screening modalities - fecal occult blood test FOBT , fecal immunochemical test FIT , double-contrast barium enema, computed tomography CT colonography, flexible sigmoidoscopy, and others - colonoscopy remains the gold standard test for detection of CRC [ 21 ].
The spontaneous expulsion per rectum of a polyp is rare, and the literature regarding such cases is limited. There have been several reported cases of rectal expulsion of lipomas [ 22 - 29 ]. With an incidence of 0. In rare circumstances, the lipoma can self-detach and be expelled from the rectum.
Such spontaneous expulsion primarily takes place among large, pedunculated lipomas that separate from their pedicles. The lipoma may necrose as it twists upon its pedicle or as that particular colonic segment intussuscepts [ 28 ]. To our knowledge, this is the first published case of spontaneous expulsion of an adenomatous polyp during defecation. The exact mechanism of self-detachment of the colorectal polyp is not well understood.
Similar to lipomas, in large, pedunculated polyps, the pedicle can become twisted and strangled, leading to necrosis and self-amputation of the polyp. The base of this polyp indeed appeared necrotic on histology. Also, chronic constipation, as in our patient, can result in damage to the mucosal lining. Conceivably, a hard, dry stool could shear a large, pedunculated polyp from its base, causing it to be expulsed from the rectum. In our patient, given the adenomatous histopathology of the expulsed polyp, a complete examination with colonoscopy was warranted.
In conclusion, colorectal polyps are fairly common, and the complete removal of adenomatous polyps during colonoscopy prevents the development of cancer. Meanwhile, the spontaneous expulsion per rectum of such polyps is exceedingly rare. Such a patient should undergo colonoscopy to search for additional polyps as well as other gastrointestinal pathology. The authors of this case report declare that no financial support nor grant support has been received for the preparation of this manuscript.
The authors of this case report declare that they have no competing interests. National Center for Biotechnology Information , U.
Journal List Gastroenterology Res v. Gastroenterology Res. Published online Feb 8. Jamil Shah a, c and Abul Shahidullah b. Author information Article notes Copyright and License information Disclaimer. Email: moc. Received Jun 2; Accepted Jun Copyright , Shah et al.
Abstract Colorectal polyps are growths that form on the epithelium of the colon and rectum. Keywords: Colorectal polyp, Expulsion per rectum, Polypectomy. Introduction The development of colorectal polyps, particularly adenomatous polyps, is associated with several risk factors, including age i. Case Report A year-old man, with past medical history of hypertension, diabetes mellitus, schizophrenia, and chronic constipation, visited his gastroenterologist with complaints of worsening lower abdominal pain and constipation for several weeks, not relieved with stool softeners and laxatives.
Open in a separate window. Figure 1. Figure 2. Figure 3. Discussion Colorectal polyps, growths protruding into the colorectal lumen above the surrounding mucosa, can be neoplastic or benign. Conclusions In conclusion, colorectal polyps are fairly common, and the complete removal of adenomatous polyps during colonoscopy prevents the development of cancer. Financial Disclosures The authors of this case report declare that no financial support nor grant support has been received for the preparation of this manuscript.
Conflict of Interest The authors of this case report declare that they have no competing interests. References 1. The value of colonoscopic surveillance after curative resection for colorectal cancer or synchronous adenomatous polyps.
Arch Surg. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history.
Am J Gastroenterol. Rex DK. Colonoscopy: a review of its yield for cancers and adenomas by indication. Occurrence of colorectal adenomas in younger adults: an epidemiologic necropsy study. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Patel K, Hoffman NE.
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Barium enema - Mayo Clinic
A barium enema is a radiographic X-ray examination of the lower gastrointestinal GI tract. The large intestine , including the rectum, is made visible on X-ray film by filling the colon with a liquid suspension called barium sulfate barium. Barium highlights certain areas in the body to create a clearer picture.
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film for diagnostic purposes. Fluoroscopy is often used during a barium enema. Fluoroscopy is a study of moving body structures — similar to an X-ray "movie.
In a barium enema, fluoroscopy allows the radiologist to see the movement of the barium through the large intestine as it is instilled through the rectum. Barium is a dry, white, chalky, powder that is mixed with water to make barium liquid.
Barium is an X-ray absorber and appears white on X-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine.
This allows for visualization of the inner wall lining, as well as the size, shape, contour, and patency of the colon. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract. The use of barium with standard X-rays contributes to the visibility of various characteristics of the large intestine. Some abnormalities of the large intestine that may be detected by a barium enema include tumors, inflammation, polyps growths , diverticula pouches , obstructions, and changes in the intestinal structure.
After the instillation of barium into the rectum, the radiologist may also fill the large intestine with air. Air will appear black on X-ray film, contrasting with barium's white image. The use of the 2 substances, barium and air, is called a double contrast study. The purpose of using 2 contrast substances is to achieve an enhancement of the inside wall lining of the large intestine.
As the air expands the large intestine like blowing up a balloon , a barium coating is formed on the inner surface of the colon wall. This technique enhances visualization by sharpening the outline of the inner surface layer of the large intestine. The benefit of this technique is to show smaller surface abnormalities in the large intestine.
Other related procedures that may be used to diagnose lower GI problems include colonoscopy , virtual colonoscopy , abdominal X-ray , CT computed tomography scan of the abdomen , and abdominal ultrasound. Transverse colon. Extends from the ascending colon across the body to the left side.
Sigmoid colon. Named because of its S-shape; extends from the descending colon to the rectum. A barium enema may be performed to diagnose structural or functional abnormalities of the large intestine, including the rectum. These abnormalities may include, but are not limited to:. Ulcerative colitis. Ulcerations and inflammation of the large intestine. Crohn's disease. Ulcerations and inflammation occurring in any part of the GI tract mouth to anus.
Irritable bowel syndrome. Changes in bowel movements. You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation.
It's a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your health care provider. If you're pregnant or suspect that you may be pregnant, you should notify your doctor. Radiation exposure during pregnancy may lead to birth defects.
Patients who are allergic to or sensitive to medications, contrast media, iodine, or latex should notify their health care provider. Constipation or fecal impaction may occur if the barium isn't completely eliminated from the body.
Toxic megacolon. There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure. Certain factors or conditions may interfere with the accuracy of a barium enema procedure. These factors include, but are not limited to:. Recent barium swallow or upper GI procedure that may interfere with the X-ray exposure of the lower GI area.
Notify the radiologist if you've had a recent barium swallow or upper GI procedure, as this may interfere with obtaining an optimal X-ray exposure of the lower GI area. A locker will be provided to secure personal belongings. Please remove all piercings and leave all jewelry and valuables at home. Based on your medical condition, your health care provider may request other specific preparation.
Step 1. Have only clear liquids for the entire day. Drinking lots of clear liquids is a very important part of the preparation. Clear liquids include:. Step 2. Have additional clear fluids throughout the evening.
Drink a minimum of four 8 ounce glasses of clear liquid. Magnesium citrate is available at any pharmacy. Step 3. Do not crush or chew tablets. Bisacodyl tablets are available at any pharmacy. You should instead continue to have clear liquids. Use one bisacodyl rectal suppository 90 minutes prior to leave home for your test. A bowel movement should occur within 30 minutes. Bisacodyl suppositories are available at any pharmacy. Bring a list of all your medications including over-the-counter medications and herbal supplements.
A barium enema may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices. You'll be asked to remove any jewelry, eye glasses, or other metal objects that may interfere with the procedure. A lubricated rectal tube will be inserted into the rectum to allow the barium to flow into the intestine. The barium will be allowed to flow slowly into the intestine. You may experience cramping in the lower abdominal area as the barium is instilled.
To lessen the discomfort, it may be helpful to take slow deep breaths. You may feel the need to have a bowel movement. It will be important to resist the urge to prevent the barium from leaking back out.
At the appropriate time, you'll be given a bedpan or assisted to the bathroom as needed. During the procedure, the machine and examination table will move and you may be asked to assume various positions as the X-rays are being taken. The radiologist will take single pictures, a series of X-rays, or a video fluoroscopy as the barium moves through the intestine.
If a double contrast study is ordered, you'll be asked to evacuate some of the barium. A bedpan or access to a bathroom will be provided. Some barium will remain in your intestine. Following the examination, some barium will be expelled immediately. You'll be assisted to the bathroom or given a bedpan. You may resume your normal diet and activities after a barium enema, unless your doctor advises you differently. Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body.
You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body. You may also be given a cathartic or laxative to help expel the barium. Since barium isn't absorbed into the body but passes through your entire gastrointestinal tract, your bowel movements may be lighter in color until all the barium has been excreted.
The long and rigorous bowel preparation prior to the procedure may cause fatigue afterward. You should rest as needed. You may experience soreness of the anus and rectum due to the bowel preparation.
Your doctor may recommend the application of a soothing ointment to the area. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation. Health Home Treatments, Tests and Therapies. Why is barium used with X-rays? Anatomy of the colon. The large intestine, or colon, has four sections: Ascending colon.
Extends upward on the right side of the abdomen Transverse colon.