Colon perforation barium enema

At least 12 cases of perforation of the colon by barium enema, with four deaths, were reported in a series of publications (SED-12,1165) (6-8). The incidence of perforation was about 1 in 6000 examinations. Even sterile barium sulfate can cause marked peritoneal irritation, with considerable fluid loss into the peritoneal cavity, but in practice it is usually a mixture of barium and feces that escapes and this, not surprisingly, produces severe peritonitis and dense adhesions. Mortality has been reported to be 58% with conservative treatment, and as high as 47% with surgical intervention (9). Early operation is indicated, and large volumes of intravenous fluids improve the prognosis. Patients who recover can... 

After a barium enema, perforation occurs rarely in children and debilitated adults or when the colon is already weakened by inflammatory, malignant, or parasitic diseases. Perforation can be triggered by manipulations involved in giving the barium enema or can result from hydrostatic pressure. In one case, perforation followed air contrast insufflation for barium enema in a patient in whom the sigmoid colon became trapped in an inguinal hernia. 

In air-contrast examinations, colonic perforation can actually precede the administration of the barium enema itself. In such cases it is due to the preparatory insufflation of air if this is conducted with excessive enthusiasm in a high-risk patient (for example an elderly patient with a hitherto unrecognized epigastric hernia) (10). 

Han SY, Tishler JM. Perforation of the colon above the peritoneal reflection during the barium-enema examination. Radiology 1982 144(2) 253-5. 

CTC in symptomatic patients is to be considered when colonoscopy can not be completed or carried out this may occur due to mechanical hindrance such as pelvic adhesions, in cases of high risk of perforation as in complicated diverticular disease, when there is an obstruction due to cancer or extracolonic diseases, when the cecum cannot be reached in extreme dolicocolon conditions, or in patients with poor tolerance to colonoscopy in whom heavy sedation may be dangerous (elderly patients or patients with severe co-morbidity). Such indications are similar to those of double contrast barium enema (DCBE) however, CTC has been shown to be both more accurate and better tolerated than DCBE, and should be used preferentially whenever available (Rocket et al. 2005 Taylor et al. 2005 Taylor et al. 2006). Furthermore, in cases of obstructing colonic cancer, CTC is a valuable tool, as it can be conveniently performed at the time of a contrast-enhanced abdominal CT scan for staging purposes to detect synchronous colorectal carcinomas, metas-... 

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