Roentgen Examination of the Cecum and Proximal Ascending Colon with Ingested Barium

Examination of the cecum and the proximal ascending colon with ingested barium has received little mention in the radiological literature. Ross Golden has strongly recommended this type of investigation in studies of the cecum and the colon just distal to the ileocecal valve (3, 4). Others have also mentioned that the procedure may often be worthwhile in evaluating the right colon (1, 2, 5). We have found it an extremely useful maneuver as an adjunct to the barium-enema study of the large intestine. The cecum can be difficult to examine thoroughly by barium enema. Since it is the last portion of the colon to be filled, debris and fluid may occasionally be brought to it by the enema, from the distal colon. During filling of the proximal colon the patient may be uncomfortable and unco-operative, so that an adequate fluoroscopic spot-film study is hard to obtain (Fig. 1). On occasion, it is difficult to be certain that the cecum is filled by the enema. Since elucidation of the differential diagnosis of lesions in this region requires thorough study of the mucosa and of adjacent structures (the appendix and terminal ileum), a method which will allow meticulous filming and fluoroscopic observation is valuable (Figs. 2 and 3). Further examination with oral barium is a simple additional procedure which usually solves the dilemma without discomfort to the patient (Fig. 2). Advantages of Ingested Barium The use of ingested barium for study of the proximal right colon has many advantages. The examination becomes a comfortable one for the patient and the radiologist is therefore able to study the lesion carefully and thoroughly at fluoroscopy. Spot-films with and without pressure are readily made in the supine and prone positions (Figs. 1 and 4). The relationships of the cecum to the appendix, terminal ileum, and ileocecal valve are easily demonstrable. Filling of the entire colon is assured, and the length of the right colon can be determined (Fig. 2). The ileocecal valve is easily identified and can be distinguished from a cecal abnormality (Fig. 4). The proximal margin of a right-sided colonie lesion, which produces obstruction to the retrograde flow of barium administered by enema, can be visualized (Fig. 2). Lesions of the colon in the vicinity of the ileocecal valve may obstruct the retrograde flow of barium but will not necessarily interfere with the antegrade flow. It is worthy of emphasis that the colonic contents in this region are liquid. Adequate mucosal detail is more consistently demonstrated by this method than by the barium enema, for it is not uncommon that in the post-evacuation phase of the latter examination the mucosa of the proximal colon is not well delineated. Indications We have found that there are three distinct indications for oral ingestion of barium after the barium-enema study has been performed.