Case of rectal perforation after gastrography

Abstract

Although barium peritonitis is very rare, it is potentially lethal. We recently treated a 47-year-old woman who developed severe lower abdominal pain after gastrography.
Abdominal plain X-ray and CT scan images revealed extravasation of barium into the peritoneal cavity. Emergency laparotomy was performed under the diagnosis of barium peritonitis with septic shock due to perforation of the digestive tract.
Perforation was noted at the rectum, and peritoneal lavage with warm saline was performed following Hartmann's surgery. Postoperative inflammation and paralytic ileus took a month to resolve. The patient was discharged on the 35th postoperative day ; 8 months after the initial surgery, stoma closure was successfully performed. Barium peritonitis often causes intense and prolonged inflammation with severe complications such as paralytic ileus. Gastrography should be done with an understanding of the potential untoward effects.