Barium Enema (Colon X-ray, barium only)

What it is

The colon is a hollow tube, and on an ordinary x-ray a hollow tube full of stool and gas is close to unreadable. Filling it with barium — a chalky liquid the x-ray beam cannot pass through — turns it into a solid white cast, so its shape, width, and path can be traced from the rectum around to where the small bowel joins it. The radiologist watches on a live x-ray screen as the barium advances and takes pictures as it goes. The word single in the description matters: in the double-contrast version, air is introduced after the barium so that only a thin coating is left on the wall and the surface detail shows. A single-contrast study fills the colon solidly instead, which is better suited to questions about shape, narrowing, blockage, and leaks than to questions about small growths on the lining. This code also includes plain abdominal films and further images taken after a delay.

Why it is done

• To show a narrowing or a blockage of the colon, and to see how far the barium can get past it
• To trace the shape and course of the colon when a twist, an abnormal position, or a segment pushed out of place is suspected
• To look for a leak or an abnormal connection between the colon and another structure, including at a surgical join being checked before a stoma is reversed
• To examine parts of the colon a colonoscopy could not reach, or when a colonoscopy is not an option
• In children, to investigate a colon that is not working as it should, where the pattern of filling is itself the finding

What to expect

The colon must be empty, so there is a preparation the day before — clear liquids and a bowel-cleansing regimen given by the department. In the x-ray room, a small flexible tube is placed in the rectum and barium runs in by gravity from a bag. The sensation is fullness and cramping, sometimes strong, along with a powerful urge to go; the tube is designed to hold the barium in. The table tilts and the patient is asked to roll into different positions so the barium moves around each bend. Pictures continue after the colon is emptied, and further delayed images may follow. Afterward, stools look chalky white for a day or two and extra fluids help clear the barium. A radiologist performs and reports the study.

Questions worth asking

• Is there a separate charge for the radiologist's time supervising the fluoroscopy, on top of the charge for the examination itself?
• Is the bowel preparation given by the department, or a prescription I collect and pay for at a pharmacy?
• If this study is done because a colonoscopy could not be completed, will both procedures be billed, and is the second one still covered?
• If the study is inconclusive and a CT of the abdomen follows, is there any discount for the two being done close together, or two full charges?
• Is the facility doing this a hospital radiology department, and does an outpatient imaging centre nearby do contrast enemas at a different price?