Barium Peritonitis Caused by Oral Side Perforation of Cancer of the Transverse Colon Following Upper Gastrointestinal RadioGraphy:Report of a Case

Abstract

We report on a patient who survived surgery for barium peritonitis caused by oral side perforation of cancer of the transverse colon following upper gastrointestinal radiography. A 64-year-old man was referred to a physician because of a sensation of abdominal fullness. Upper gastrointestinal radiography was performed, and on the following day the patient suddenly suffered abdominal pain. He was referred to another hospital and was diagnosed as having barium peritonitis by plain X-ray film and abdominal computed tomography. He was admitted to our hospital and underwent emergency surgery. On laparotomy panperitonitis was demonstrated due to massive feces and barium dissemination, and perforation of the oral side of the transverse colon due to a tumor. Resection of the affected lesion, creation of a transverse colostomy and mucous fistula, and intraperitoneal drainage were performed with intraperitoneal lavage using 30 L saline. He was discharged 33 days after surgery, although intensive care including direct hemoperfusion with polymixin-immunobilized fibers was required postoperatively. The tumor of the transverse colon was a moderately differentiated adenocarcinoma classified as stage IIIB according to the pTNM classification. The patient is currently well without evidence of recurrence 11 months after surgery.