Patient Information
Tests and Treatments: Diagnostic Tests: Diagnostic Radiology: Small Bowel Follow-Through
As far as the patient is concerned, the small bowel follow-through is a very straightforward examination. It essentially consists of the patient ingesting a least two large cupfuls of a dilute liquid barium. Following this the radiologist will use the X-ray machine to follow the passage of barium through the stomach and into the small intestine. It is possible to evaluate the small intestine in terms of its diameter, peristalsis (movement), and whether or not there is any abnormal filling defect within the bowel or whether there is abnormal holdup to the flow of barium. The duration of the examination is variable and essentially depends on the transit time from stomach to large bowel (the time taken for barium to pass from the stomach to the large bowel). Normally this is approximately one to two hours but in some patients it may take up to four hours and still be normal.
In order to produce a good examination it is necessary that the small bowel continues to fill with barium and moves in a satisfactory manner. This is most likely to happen if the stomach remains full and therefore it is necessary for the patient to keep drinking sufficient quantities in order for the stomach to remain distended with fluid. The radiologist will intermittently screen the patients abdomen to assess the passage of barium and to take images to document any abnormal finding.
In between X-rays it is usual for the patient to lie on their right side in order to encourage fluid to pass from the stomach into the small bowel. Once the barium reaches the large bowel (colon), the radiologist will spend some time examining the terminal portion of the small bowel (the terminal ileum). This may involve some sort of compression device pressing down on the right-lower portion of the patient's abdomen in order to better distend the bowel. Such compression devices (spoon or gloved hand) may be used at any point during the examination in order to better separate loops of bowel and to confirm whether or not they are indeed normal or abnormal.
Once the barium has reached the colon the patient is usually asked to visit the bathroom and a single further X-ray (radiograph) is obtained in order to provide an overview of the barium within the small and large bowel.