A Simple One-Stage Method of Double-Contrast Study of the Colon

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Abstract
THE DOUBLE-CONTRAST examination of the colon was first described by Fischer (1) in 1925. It has been popularized in this country by Weber and Gershon-Cohen, but we feel that it has not been utilized to its fullest extent. Realizing that the method previously described by one of us (4) is rather time-consuming and, as pointed out, may be completely ineffectual if the patient lingers too long at evacuation, we have devised a new and simpler procedure, with a special adapter to be used in carrying out the examination. The importance of proper preparation of the patient bears re-emphasizing. Thorough cleansing of the bowel by both purgatives and small enemas is most essential for any reliable colon examination, the only contraindications being severe diarrhea, severe hemorrhagic tendencies in the gastro-intestinal tract, and acute or subacute obstruction. After studying various types of barium (5), we now use a commercial preparation of barium sulfate containing a ready-mixed “suspending agent.” We measure the barium by exact weight rather than volume and feel that this gives a more uniform mixture. The mixing is done in a baker's dough mixer, though in private practice or hospital practice an electric butter churn will serve the purpose. We have found that the capacity of a regular malted milk mixer is not sufficient to afford uniform mixing of the entire solution. Apparatus used for the double-contrast examination consists of the usual tilt-table fluoroscopic machine with a “spot-taking” attachment, a 2-quart metal enema can of common design with an attached 3- or 4-foot rubber tube of adequate size, a suitable clamp for the tube, a Carman metal enema tip, a Weber insufflator, and the special adapter mentioned above. The adapter (Fig. 1B) is a Y-type attachment threaded on one end for connecting the rubber tube to the enema can and on the other for attaching a Weber insufflator. To the single end of this adapter the Carman tip is attached (with the aid of an accessory, a Bardex catheter or any other type of rubber tip may be used). With this adapter the enema solution or air may be controlled at will. When all is in readiness, the enema tip is inserted by an assistant. Then, after a preliminary “scout glimpse” of the abdomen, the barium solution, which has been previously heated to body temperature, is allowed to run slowly into the bowel. The opaque column is observed under the fluoroscope until it just reaches the splenic flexure (Fig. 2A). Since air is lighter than the barium, the table is tilted to a Trendelenburg position and the patient is rotated to the left. The assistant then injects the air at a moderate, steady rate. The head of the barium column is observed fluoroscopically and after an interval of a few moments for the barium to clear the sigmoid, the patient rolls on his back and slightly to the right.
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