The large bowel may become perforated during a barium enema.
Causes of the perforation:
(1) puncture of the bowel wall by the enema catheter tip
(2) combination of a high intraluminal pressure and a bowel wall defect (rupture diverticulum, etc.)
If the sigmoid colon is perforated, then barium and free air may enter the peritoneal cavity. Management involves immediate laparotomy with closure of the bowel wall defect and removal of the barium. Removal of barium may be difficult since it will adhere to the peritoneal surface.
If the extraperitoneal rectum is perforated then the amount of extravasation may be limited by the perirectal soft tissue. A small lesion can be managed nonoperatively.
Additional management includes close patient monitoring and parenteral antibiotics. The patient should have monitoring for late complications such as adhesions.
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