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Perforation associated with barium enema in acute appendicitis
N Shust1, C E Blane, K T Oldham
1Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0252.
Insights
A rare complication of barium enema, a diagnostic tool for appendicitis, occurred when barium leaked into the abdominal cavity. Despite this rare risk, barium enema remains valuable for uncertain appendicitis diagnoses.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Appendicitis diagnosis can be challenging, especially in atypical cases.
- Barium enema has been used historically for appendicitis evaluation.
- Assessing the risks and benefits of barium enema is crucial.
Observation:
- A child with suspected atypical appendicitis experienced a barium enema.
- The diagnostic procedure resulted in a rare complication: barium perforation and leakage into the peritoneal cavity.
- This led to a complex hospital course for the patient.
Findings:
- The complication of barium leakage during appendicitis diagnosis is extremely rare.
- Literature review confirms the rarity of this specific barium enema complication.
- The study reevaluates the role and contraindications of barium enema.
Implications:
- Despite the rare risk of perforation, barium enema retains a diagnostic role in select cases of uncertain appendicitis.
- Careful patient selection and procedural awareness are essential when considering barium enema.
- This case highlights the need for continued evaluation of diagnostic imaging safety and efficacy.
Abstract:
A child with the suspected diagnosis of atypical acute appendicitis underwent a diagnostic barium enema. The study was complicated by perforation with leakage of a large amount of barium into the peritoneal cavity. The complex hospital course that resulted has prompted us to reevaluate the barium enema in the diagnosis of appendicitis and review the literature for contraindications. We conclude that this particular complication is extremely rare and that barium enema still has a part to play in some patients where the clinical diagnosis is uncertain.