Abstract
A 63-year-old woman who began to vomit from the next day of barium meal study of the upper digestive tract at a medical checkup presented to our hospital on the second day after the barium study. An abdominal CT scan showed leakage of barium into the abdominal cavity, and perforation of the sigmoid colon was suspected. Blood analysis revealed abnormally high level of inflammatory reaction and impaired renal function. Emergency operation was performed with a diagnosis of sigmoid colon perforation. Laparotomy demonstrated perforation of the sigmoid colon, and Hartmann's operation was performed. The patient's early postoperative course was uneventful, but she developed high fever on and after the 16th postoperative day. Blood analysis revealed strong inflammation. Despite administration of antibacterial agents, her inflammation persisted. Another abdominal CT scan revealed barium remnant in the abdominal cavity. Peritonitis caused by barium remnant was diagnosed and steroid therapy with prednisolone was started that resulted in prompt relief. The stoma was closed 5 months after the operation and no abnormalities have been seen at present. Barium peritonitis is an extremely rare and serious disease. We present a favorable outcome of steroid therapy for barium peritonitis caused by sigmoid colon perforation in which postoperative inflammatory reaction persistently existed.
