Enteroclysis

Enteroclysis according to Sellink in a patient with Crohn's disease showing a stenosis of the ileum

MR enteroclysis in Crohn disease: substantial wall thickening and contrast uptake in the affected bowel segment

Enteroclysis is a fluoroscopic X-ray of the small intestine. Radiocontrast is infused through a tube inserted through the nose to the duodenum, and images are taken in real time as the contrast moves through aided by administration of methyl cellulose. Enteroclysis is also known by the confusing misnomer small bowel enema. 'Enema' is confusing as it suggests that the contrast material is introduced through the anal route.

It was the gold standard for evaluating small bowel diseases like Crohn's, though it has largely been replaced by CT enterography. CT enteroclysis is now available which combines the advantages of CT (ample extraluminal information and visualization) and conventional enteroclysis (distension of small bowel for visualization). A report suggested CT enteroclysis to be superior to conventional enteroclysis in evaluation of symptomatic Crohn's disease, especially for the detection of fistula, abscess, skip lesions, lymphadenopathy, and conglomeration of small bowel loops.^[1]

MR and CT versions exist.^[2]

Indications

• Apart from Crohn's disease as mentioned above, enteroclysis is invaluable in small intestinal obstruction. In this condition it helps to distinguish the complete (which requires early operation) from the incomplete varieties of obstruction (or occlusion).
• Any suspicion of a large bowel (ie, colonic) obstruction precludes an enteroclysis until the possibility has been excluded. If enteroclysis is conducted in a patient suspected of large bowel obstruction, the ileocecal valve will pump the contrast material into the dilated caecum which lies proximal to the obstruction in large intestine. This can cause a perforation.

References