A Case of Conservative Treatment of Sigmoid Colon Perforation After Barium Gastrography

Abstract

The patient was a 72-year-old woman who presented with the chief complaint of lower abdominal pain. She had taken a barium test a week earlier and had not had a bowel movement in five days. Physical examination revealed tenderness localized to the lower abdomen and muscle guarding. Blood tests showed elevated inflammation marker levels, and abdominal contrast-enhanced CT scan showed a fecal mass with barium, extraintestinal gas near the sigmoid colon, and a fatty tissue opacity in the adjacent region. We made the diagnosis of perforation of the sigmoid colon occurring as a complication of barium gastrography and peritonitis, and considered emergency surgery, but the abdominal pain had passed its peak severity and was localized to the lower abdomen, and there was no evidence of generalized peritonitis, we decided to start the patient on conservative treatment. She responded well without needing surgery, and was discharged on the 15th day. Perforation after barium gastrography is rather rare, but when it does occur, emergency surgery is usually required and treatment is often difficult. We describe a patient who developed colonic perforation as a complication of barium gastrography, in whom we could avoid surgery.