Non-operative management of barium peritonitis: a case report

Barium peritonitis is a rare but serious complication caused by leakage of barium sulfate into the peritoneal cavity during gastrointestinal contrast studies. It carries high mortality and often necessitates surgical intervention. A 33-year-old female developed chemical peritonitis following a barium loopogram performed during her ileostomy reversal workup. Imaging revealed pneumoperitoneum and intra-abdominal collections due to barium spillage. Despite radiological findings, she remained clinically stable with only localized symptoms. Conservative management was pursued with intravenous antibiotics, hydration, analgesia, and CT-guided drainage. Surgery was avoided due to her stable clinical status and normal inflammatory markers. She recovered completely without in-hospital complications and remained asymptomatic on follow-up. This case demonstrates that conservative management of barium peritonitis is a viable option in selected stable patients. It also highlights the need to reconsider the use of barium-based contrast agents in favor of safer alternatives, especially in high-risk individuals.