A case of barium peritonitis with prolonged postoperative inflammation

Abstract

Barium peritonitis is a rare and potentially lethal event. We report a patient with barium peritonitis due to perforation of the rectum following upper gastrointestinal contrast investigation, whose prolonged postoperative inflammation was successfully treated by steroid regimen.
A 72-year-old woman was admitted to our hospital complaining of severe abdominal pain on the following day after she received an upper gastrointestinal contrast investigation. Tenderness and muscular defense were present in the entire abdomen, and the laboratory data showed marked decrease in white blood cells. Abdominal plain X-ray and CT scan revealed extravasation of barium into the peritoneal cavity. We diagnosed the case as barium peritonitis with sepsis due to perforation of the digestive tract. At emergency laparotomy, a perforated rectum was noted, and extensive peritoneal lavage with warm saline was performed following Hartmann's surgery. The postoperative inflammatory response was prolonged because of remnant barium in the abdominal cavity. The intubation and respirator control were needed on the 30th postoperative day, and the inflammation was eventually controlled by administration of steroid.