A Case of Prolonged Inflammatory Reaction Due to Intraperitoneal Residual Barium after Barium Peritonitis Surgery That Was Successfully Treated with Steroid Pulse Therapy

Abstract

A 55-year-old male presented with lower abdominal pain three days after undergoing an upper gastrointestinal series. The patient was diagnosed with acute generalized peritonitis secondary to sigmoid colon perforation, and a Hartmann’s operation was performed. Postoperatively, despite administration of antibiotics and drainage of an intra-abdominal abscess, the patient had persistent fever and a prolonged inflammatory response. Peritonitis associated with intraperitoneal residual barium was suspected, prompting initiation of steroid pulse therapy, which reduced the inflammatory response. On postoperative day 198, the patient underwent a colostomy reversal without complications. This case suggests that in patients with persistent inflammation despite good infection control, the possibility of peritonitis due to a foreign body reaction should be considered. Steroid pulse therapy may be an effective treatment option for managing prolonged peritonitis associated with intraperitoneal residual barium.