Intramural extravasation of barium simulating carcinoma of the rectum

This report describes two patients found to have barium granuloma of the rectum. The lesions appeared as indurated, ulcerated rectal masses that resembled carcinoma on endoscopic examination. Deep mucosal biopsy results demonstrated no malignancy and barium sulfate crystals in tissue macrophages. Radiographs showed persistent soft-tissue barium in the rectum. Past reports of barium granuloma have described ulcerated or polypoid masses in the rectum and anus. Rectal intramural extravasation of barium occurs as a result of asymmetric enema balloon inflation and impaction of the enema tip against the rectal mucosa.