From the Guidelines
For ileus, a hyperosmolar enema like sodium phosphate (Fleet enema) is typically recommended, while for bowel obstruction, a water-soluble contrast enema such as Gastrografin is preferred for both diagnostic and potential therapeutic purposes. The choice of enema depends on the specific condition being treated. For ileus, the goal is to stimulate motility, whereas for bowel obstruction, the aim is to diagnose and potentially treat the obstruction. According to a study published in the World Journal of Emergency Surgery 1, water-soluble contrast enemas have a high sensitivity and specificity in diagnosing large bowel obstruction, but cannot distinguish between different causes of obstruction.
In the case of bowel obstruction, it is crucial to use enemas with caution, as they may worsen complete obstructions or risk perforation. The administration of water-soluble contrast agents in adhesive small bowel obstruction is safe in terms of morbidity and mortality, but adverse effects such as aspiration pneumonia and pulmonary edema have been reported 1. To minimize these risks, the contrast medium should be administered when the stomach has been adequately decompressed through a nasogastric tube.
For diagnostic purposes, a water-soluble contrast enema can be used as an alternative to computed tomography (CT) scan, especially when CT scan is not available 1. The dosage of the contrast medium can range from 50-150 ml, administered either orally or via nasogastric tube 1. It is essential to note that enemas are generally adjunctive treatments, and the underlying cause of either condition should be addressed simultaneously.
Key considerations when using enemas for ileus or bowel obstruction include:
- The type of enema used (hyperosmolar for ileus, water-soluble contrast for bowel obstruction)
- The dosage and administration route of the contrast medium
- The potential risks and adverse effects associated with enema use
- The importance of addressing the underlying cause of the condition being treated.
From the Research
Enema Administration for Ileus vs Bowel Obstruction
- The type of enema used for ileus vs bowel obstruction is not explicitly stated in the provided studies, but some insights can be gathered from the available evidence.
- For ileus, a study on the efficacy and safety of subcutaneous neostigmine 2 suggests that neostigmine may be a reasonable option for management, but it does not discuss enema administration specifically.
- In terms of enema solutions, a study comparing the effectiveness and side effects of different enema solutions 3 found that soapsuds and tap water enemas produced greater returns than polyethylene glycol-electrolyte solution, but were also more uncomfortable and caused surface epithelium loss.
- Another study on soap suds enemas in children with abdominal pain 4 found that they were efficacious and safe for treating fecal impaction, with a success rate of 82% and minimal adverse events.
- A review of ileus in critically ill patients 5 discusses the causes, treatment, and prevention of ileus, but does not provide specific guidance on enema administration.
- A nursing article on how to administer an enema 6 provides general guidance on the procedure, emphasizing the importance of patient-centered care, privacy, and dignity, but does not address the specific context of ileus vs bowel obstruction.
Enema Solutions
- Soapsuds enemas may be effective for treating fecal impaction, but may cause discomfort and surface epithelium loss 3, 4.
- Polyethylene glycol-electrolyte solution enemas may be less effective, but are also less uncomfortable and do not cause surface epithelium loss 3.
- Tap water enemas may be effective, but may also cause discomfort and surface epithelium loss 3.