Barium studies of the small bowel

Last revised by Andrew Murphy on 27 Sep 2021

Barium studies of the small intestine are still considered an effective modality to show the bowel loops in a cost-effective way.

  • improved technique to show small bowel mucosal pattern with double contrast (air and oral contrast) 
  • a long tube is introduced and its tip is placed at the duodenojejunal angle and beyond
  • a manageable pump is necessary for insufflation
  • requires about 10 minutes or more fluoroscopy
  • although the advantage of the technique is showing individual small bowel loops in great detail, increased radiation dose to the patient, and lack of the necessary tools for enteroclysis means it is not used routinely and it is often an academic technique
  • at the moment when the oral contrast column from the ileum enter the cecum, introduce air by insufflation into the colon
  • as the ileocecal valve is patulous in 90% of people and air could easily enter the ileum, double contrast imaging is acquired for this region by this technique called peroral pneumocolon

On a normal barium study of the small bowel, the jejunum is located in the upper left abdomen and the ileum in the lower right abdomen, to be continued by the colon in the ileocecal region. This configuration must be shown in any series of the small intestine. There is no definite border between jejunum and ileum, however, more than half of the small bowel is ileum.

The mucosa of the small bowel is characterized by the existence of the valvulae conniventes (also referred to as Kerkrin valves or circular folds). These folds start from the second part of the duodenum, which has a greater number of them, and they decrease in number as the small bowel approaches the ileocecal valve. With gaseous distension of the bowel loops, they are never completely effaced in the jejunum but they may be effaced in the ileum.

In the small intestine, a barium exam may reveal:

Contraindications for a barium swallow may include:

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Cases and figures

  • Small bowel barium study (normal pattern)
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  • Small bowel barium study - normal pattern - annotated
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