A Barium Swallow Study Leading to an Incidental Finding on a Screening Colonoscopy

Abstract

Barolith is a mixture of firm feces with barium sulfate, and a frequent cause of obstruction of the appendiceal lumen that can result in appendicitis. Nonetheless, some other complications like aspiration, allergic reaction, and bowel obstruction have also been reported. We present the case of a 71-year-old man with a history of amyotrophic lateral sclerosis (ALS), who came to the gastroenterology clinic complaining of intermittent loose stools and dysphagia to solids for the past months. The patient underwent a barium swallow study six days prior and was completely normal. A colonoscopy was done showing normal appearing mucosa, with a whitish foreign object found on the appendiceal orifice. Removal of the barolith was done by means of a biopsy forceps.Our patient did not have any signs or symptoms of appendicitis prior to the procedure, and the successful removal of the barolith was achieved. Elderly patients, and patients with decreased gastrointestinal (GI) transit, could be a population at risk for barium retention/appendicitis; for this reason, more research studies should be done to assess possible preventive treatments.

Surgical Management of Barium Impaction: A Case Report

“…The presentation for a barolith impaction can vary from mild nausea to severe abdominal pain and distention. In our patient's case and others in the literature, common presenting signs on admission were abdominal pain and an elevated white count [2,[4][5][6][7][8][9][10]. Our patient did reveal that she had not had a recent bowel movement, which helped direct our treatment plan.…”

“…Barolith impactions are relatively rare, with Kurer et al finding only 31 patients with a barolith impaction in a systemic review occurring from 1950-2006 [5]. It is hypothesized that elderly patients are more at risk for barium impactions due to decreased gastrointestinal transit times [8][9][10]. One can also assume that patients with medical conditions that affect colon motility, drug use, and anatomical changes causing narrowed colonic lumen are at an increased risk of barolith impactions [8].…”