Barium peritonitis has complicated:
(1) barium meals/swallows
(2) barium enemas
(3) barium studies of colostomy sites
Features of barium peritonitis:
(1) Barium adheres to the peritoneal surface and is difficult to remove.
(2) Depending on the location of the perforation, enteric bacteria may also be present resulting in a bacterial peritonitis..
(3) The cecum may be the site of rupture for a barium enema due to intraluminal pressures.
Presentation (abdominal pain, fever, hypotension) may be:
(1) immediate (on the table)
(2) a few hours later
(3) delayed
A water-soluble contast medium should be used if the risk of a perforation is high.
Other measures:
(1) limit the volume of fluid given (barium enemas should not exceed 4,500 mL in the usual adult)
(2) the fluid should not be introduced too rapidly
Management may involve:
(1) vigorous resuscitation
(2) broad-spectrum antibiotics
(3) surgical closure of the bowel wall defect
(4) removal of barium (and food or feces if present)
(5) copious peritoneal lavage
(6) fluid and nutritional support
