A Case of Sigmoid Colon Perforation Due to Barium Fecal Stone That Occurred a Day After Barium Gastrography

Abstract

A 53-year-old Japanese man presented to our hospital with severe left lower abdominal pain a day after barium gastrography. Abdominal computed tomography showed extraintestinal gas around the sigmoid colon and stagnated barium in the rectum. We made the diagnosis of sigmoid colon perforation and performed emergency operation. Laparotomy revealed perforation of the sigmoid colon with local peritonitis. In addition, an extremely hard, oval foreign object was palpable in the rectum. This was identified as a barium fecal stone, which caused the sigmoid colon perforation mechanically. Partial sigmoidectomy including the perforation site, extraction of the rectal fecal stone, and covering ileostomy were performed. The postoperative course was good and the patient was discharged 3 weeks after the surgery. Stoma closure was performed 2 months after the initial surgery. In Japan, colonic perforation related to barium gastrography is extremely rare, but should be borne in mind, as it is a severe complication resulting from a medical diagnostic procedure. We report the clinical course and operative findings of this case for safety management.