Use of barium for diagnosis of colonic perforation leads to challenging barium peritonitis
A patient in their 60s with obesity (body mass index 49.3) presented with abdominal pain after a screening colonoscopy. At the outside hospital, a barium enema was performed which demonstrated extravasation of barium into the peritoneum. Figure 1A demonstrates the patient’s scout film from their CT abdomen/pelvis (CTAP) scan after barium enema. They were transferred to our quaternary referral center for emergent evaluation, and on arrival, they were afebrile and tachycardic. Abdominal examination demonstrated lower abdominal peritonitis and prominent ventral hernia with overlying skin changes. (figure 2A) Figure 1 (A) Patient’s scout CT film on presentation to emergency department and (B) 1 month after initial operation. Figure 2 Intraoperative photos including (A) external abdomen prior to exploratory laparotomy and (B) adherent serosal silver-white barium deposits present upon entry into the abdomen. 1. CTAP with intravenous contrast 2. CTAP with oral contrast 3. CTAP with water-solu