Perforation of the colon above the peritoneal reflection during the barium-enema examination.

Abstract

Four cases of perforation of the colon above the peritoneal reflection during a barium-enema examination were reviewed with regard to the type of examination, site of perforation, status of the colon, clinical manifestations, mode of detection, and consequences. Perforation above the peritoneal reflection does not seem to be directly related to technical factors. The cecum and ascending colon, with their larger lumina, are the most likely sites. Because such patients are usually asymptomatic at the time, careful examination of post-fluoroscopic radiographs for signs of perforation is strongly recommended.

Safety of colon contrast material in (helical) CT examination of patients with suspected diverticulitis

“…Confirmation was also provided by the surgical reports and/or clinical follow-up. The lack of apparent contrast extravasation even in cases of perforated diverticulitis in our study compared to other reports in the literature [23,24,25] is probably due to the way in which the contrast was instilled only by gravity, together with the absence of air insufflation. A certain discomfort for patients receiving colon contrast cannot be prevented; on the other hand, problems associated with swallowing oral contrast, especially in patients with nausea and abdominal pain, were avoided.…”

“…However, there has been a reluctance to perform retrograde administration of colon contrast in acute diverticulitis because of the fear of disturbing a sealed perforation or causing perforation of still intact but weakened colonic wall. Extravasation of barium and subsequent barium peritonitis has been shown to be a rare, but feared complication with possible fatal outcome [23,24].…”

“…The concerns that have been raised about the safety of rectally administered contrast in patients with diverticulitis [23,24] were based on reports of patients who suffered colon perforation during barium enemas. Nelson et al's [23] was a study of 42,000 barium enemas, 16,325 proctosigmoidoscopies, and 1207 colonoscopies performed by the Cook County Hospital house staff during an 8-year period.…”

CT evaluation of appendicitis and diverticulitis. Part II: Diverticulitis

“…However, the concern that water-soluble rectal contrast will produce or worsen perforation and peritonitis in patients with diverticulitis does not appear well supported in the literature. With barium enema perforation has been shown to be a rare but ominous possibility, occurring with a reported frequency of 0.02±0.04 % [24,25,26]. Of all reports concerning the CT evaluation of diverticulitis in which complications have been mentioned, there have been no complications with the use of either rectal air or water-soluble contrast [2,9,14,16].…”

CT evaluation of appendicitis and diverticulitis. Part I: Appendicitis

“…All seven patients died [27]. In a different study, 4 of 23,500 patients suffered perforation during barium enema, and half of them died [28]. Another investigation showed a perforation rate of 4 in 10,000 patients who received either barium or water-soluble contrast [29].…”