Hydrocolonic sonography - sounds interesting

This is a new(ish) bowel cancer screening test that a few papers have evaluated for use as an alternative to barium enema or colonoscopy. It appears to be slightly less sensitive, but is suggested for use where an X-ray machine or colonoscope is unavailable, or radiation exposure is contraindicated. I won't link to the papers as they are all behind paywalls (I can get access to them through my university). The test has some interesting medfet potential.

Basically it is an ultrasound of the colon performed while it is distended with a large water enema to improve the view of the colon walls (up to two litres was used in the paper, so large for current medical practice, but not massive). The interesting bit is that a spotlessly clean colon is needed, as it is impossible to differentiate stool from tumours by ultrasound. After a normal laxative prep as for colonoscopy the patient is given a colonic irrigation with a modified barium enema nozzle (water goes in through the air hose and comes out through the normal water hose, balloon is kept inflated). After clear returns are obtained the patient is given one last fill and her full colon is examined by abdominal ultrasound. Finally the nozzle is removed and the rectum is scanned via the perineum.

I really like the potential of this for play exams (more so than barium enemas, where it would be difficult to mimic the feel of the barium, or the X-ray machine). All you need apart from the enema equipment and a waste container for the colonic is something to mimic an ultrsound probe (maybe a massager - for an exciting if unrealistic touch, get one that vibrates), some KY jelly or ultrasound gel (available on amazon!) and a laptop with an ultrasound video running on a loop which you can play and pause. Of course, I would skip the unpleasant laxative prep and prepare the patient with enemas until (mostly) clear before starting her colonic irrigation! The ultrasound probe gliding over a tummy stretched tight by a large enema would feel great and give a fantastic visual too! Of course there is all sorts of potential for deviousness here - maybe the image isn't clear and the patient needs more water to really stretch out the folds in her colon, or the best view of the rectum is with a trans-vaginal approach. I think I need to find myself a play patient and try this out!

P.S. Genders used reflect my orientation, this test is by no means female specific.

Sounds interesting. Just be careful with your play patient.

Of course - It's just a fantasy at the moment in any case. I wouldn't try this with anyone who isn't experienced with enemas, and definately make the enemas/irrigation an isotonic salt solution - there's potential for nasty electrolyte imbalances if plain water is used for too many enemas in a row (although the research study did use plain water enemas they wouldn't need many due to the previous laxative prep).

Probably should have mentioned that point before. Oops.

Sounds good, would like to see a vid or so of it

IF they are recruiting for test patients? Where do we all sign up?

Well, first of all, that particular study has finished, and secondly it was based in Thailand - sorry! I'd also be signing up like a shot!

P.S. There was once a research study recruitment ad posted to my university mailing list looking for healthy controls for anorectal manometry (basically they insert a balloon into the rectum and inflate it to measure the pressure of any contractions, a fleet enema is usually also needed beforehand). I swear, within 15 minutes there was another email saying the study was full. Other studies hang around for days, even the MRI ones where you get cool pictures of your brain. I guess medfet is more popular than I realised! I was annoyed I didn't see that email until it was too late.

Well, what do you know - another research study in Italy in the 1990's did evaluate the transvaginal approach + water enema for examination of the rectum with good results (although they used it for rather sad things like end stage rectal cancer evaluation). They used 1500cc of water, a right lateral position and a vaginal probe inside a condom which was inflated with 20-40ml water to improve contrast. So now I get to have my (unfortunately currently hypothetical) patient change position while holding a full enema, and insert a vaginal probe which I then inflate with water [rubs hands together gleefully].