PMC3487145_01
High-density barium enema with multiple diverticula. The high-density barium (800 ml of 171.5% w/v suspension in water) was instilled by gravity into the colon. Contrast filled the colon, and after repeated position changes by the patient, numerous diverticula were noted scattered from the sigmoid colon to the cecum.
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F1
The patient was asked to change position every 5 min by rolling 90 degrees to the next of four positions over a two-hour period, and at the end of the examination none of the barium could be expelled by the patient (fig. 1).
Remaining barium in the diverticula at 48 h post procedure. After 48 h of liberal oral fluids and ambulation to minimize any risk of colonic impaction, the patient was able to tolerate clear liquids without any nausea, vomiting, or abdominal pain. This abdominal X-ray done 48 h after treatment showed barium remaining in the diverticula throughout the colon but largely cleared from the lumen proper.
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F2
The abdominal X-ray done 48 h after treatment showed barium remained in the diverticula throughout the colon but was largely cleared from the lumen proper (fig. 2).
Time course of bleeding and hemoglobin level. Three bleeding episodes occurred and were assessed endoscopically. Upper endoscopies (esophagogastroduodenoscopy for the first episode and small bowel enteroscopy for the second episode) are designated by the letter E, while colonoscopies are designated by the letter C. The tagged red blood cell scan is designated by the letter T, capsule endoscopy is designated by 'Cap', and the numbers indicate the number of units of packed red blood cells transfused. The barium impaction therapy on day 10 is designated by the letter B.
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F3
Follow-up in the outpatient clinic two weeks later showed her to be doing well with no recurrence of hematochezia, and her hematocrit was stable at 12.1 mg/dl on day 16 (fig. 3).