Extraperitoneal perforation of the rectum during barium enema

During barium enema, barium pentrated the rectum to the perirectal extraperitoneal tissue in six patients. Four of these died, and the two survivors have permanent colostomies. The incidence of this rare complication may be further reduced if barium enema is postponed after instrumentation of the rectum, the enema can not lifted more than one meter, the balloon not distended too much, the tip of the balloon catheter made very short, and the personnel in the radiological department made aware of the complication. The complication is probably best treated by prompt diverting colostomy, drainage of perirectal tissue, and antibiotics.