A Case in Which Segmental Absence of the Intestinal Musculature Led to the Development of Colonic Perforation After Barium Gastrography

Abstract

Segmental absence of the intestinal musculature (SAIM) is a rare condition, characterized by partial absence of the intestinal muscularis propria layer. A 60–year–old female patient presented to us with diarrhea two days after undergoing barium gastrography. Abdominal CT showed barium inside the sigmoid colon and free air in the adjacent region. An emergency operation was performed under the tentative diagnosis of intestinal perforation. At laparotomy, intraoperative examination revealed a fragile part of the bowel wall in the sigmoid colon and retention of stool containing barium in the mesentery; therefore, Hartmann’s operation was performed. Macroscopic and histological examination revealed the absence of the intestinal muscularis propria and intestinal perforation, which led us to the diagnosis of SAIM. It was inferred that the increase in intestinal pressure due to barium excretion might have caused perforation in the fragile part of the bowel that lacked the muscularis propria layer.