Peroral pneumocolon

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Peroral pneumocolon is a technique that can be used during a small bowel follow through (SBFT) to better visualize the ascending colon and terminal ileum.

Procedure

The goal of a peroral pneumocolon is to create a double contrast study (oral contrast and gas) of the ascending colon and terminal ileum. The double contrast approach allows the radiologist to better assess the mucosa of these segments of bowel, which may be important for evaluating inflammatory bowel disease (such as Crohn disease).

Equipment
  • small caliber pediatric enema tip with normal handheld bulb insufflator
  • some prefer carbon dioxide (CO2) insufflation
Technique
  • patient undergoes normal NPO at midnight for a small bowel follow through study:
    • some groups prefer bowel prep the day before, similar to that for a barium enema
  • small bowel follow through is performed
  • when the contrast reaches the terminal ileum:
    • 1 mg of glucagon may be administered
    • gas (ideally CO2) is insufflated into the colon through the rectum
    • in the majority of patients, the gas refluxes through the ileocecal valve into the terminal ileum
      • prone positioning may encourage gas reflux
  • double contrast images of the ascending colon and terminal ileum are acquired