Barium from a barium enema or swallow may get into the appendix. Whether or not it can cause appendicitis is a matter of controversy.
Clinical scenario:
(1) A patient has an imaging study using barium as the contrast material.
(2) A few days or weeks later the patient presents with right lower quadrant pain.
(3) An X-ray of the abdomen (if performed) shows barium within the appendix.
(4) The appendix is removed and shows appendicitis.
(5) Barium is identified within the lumen of the appendix grossly or microscopically.
Some authors believe that the barium somehow triggers the appendicitis. Others believe that the appendicitis is coincidental and reflects the length of time that barium can persist.
The presence of either a fecalith composed mostly of barium (? bariolith) or a large amount of thick barium within the lumen of the appendix might be evidence of causation.
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