Diffuse Barium Associated Peritonitis as a Complication of Barium Enema Examination

Introduction: Barium peritonitis is a rare but life threatening complication of contrast examination of the gastrointestinal tract. The chemical peritonitis due to barium contamination is characteristically severe and difficult to treat. Such a complication has a high morbidity and mortality rate.

Case Report: A 64 years old, male patient was referred immediately to our surgery department after extravasation was found during barium enema procedure. The patient underwent surgery after the diagnosis of acute abdomen was made. Exploratory laparotomy revealed perforation of the rectum with a diameter of 3 cm, located 12 cm above the anal verge and barium covering whole peritoneal cavity. There were no post operative complications found on this patients and the patients tolerate well with oral intake early on the post operative day. The post opertaive period was uneventful and the patient was discharged from hospital on the 7th post operative day. He was in good general health without any ileostomy related problems at 30 days after surgery and the closure of the ileostomy would be pending for the next 3 months.

Conclusion: Rectal perforation during barium enema examination with subsequent barium leakage into the peritoneal cavity, is a serious complication and an emergency condition. Barium-associated peritonitis associated with morbidity and with potential mortality. Early recognition and proper management are crucial for successful treatment.