What is the role of contrast barium enema in the workup of cystic fibrosis (CF)?

Updated: Oct 30, 2018
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Kenan Haver, MD  more...
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Answer

When meconium ileus is suspected on the basis of clinical and radiographic evidence, a contrast barium enema may be performed for diagnosis. One study showed a barium enema to be diagnostic in 45 (52%) patients. If meconium ileus is likely, follow the contrast enema with a therapeutic water-soluble contrast (Gastrografin) enema.

Some physicians advocate water-soluble contrast initially for both diagnosis and treatment. Controlled dilutions of Gastrografin remain the agent of choice for diagnosis and evacuation of inspissated meconium.

Fluoroscopically monitor contrast instillation in patients with meconium ileus to visualize a small-caliber colon (described as the microcolon of disuse), which often contains small "rabbit pellets" (ie, scybala) of meconium.

Progression of the contrast proximally may also outline pellets of inspissated meconium. Contrast that is successfully refluxed proximal to the obstruction allows observation of the dilated loops of small bowel.

In addition, evidence supports performing contrast enema using fluoroscopy in very low birth weight infants (average gestation age and weight, 27 wk and 788 g) in order to ensure that contrast reaches the distal ileum. Lack of contrast reflux to the distal ileum was found to be associated with unsuccessful relief of the obstruction. [55]


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