Two Cases with Perforation of the Large Intestine after Upper Gastrointestinal Series with Barium

Upper gastrointestinal series (UGIS) with barium is a routine investigation, and the incidence of serious complications associated with this procedure is very rare. We report 2 cases of perforation of the large intestine after UGIS with barium, and review relevant literature. Case 1: A 72-year-old woman presented with nausea and vomiting that had started on the 4th day after UGIS with barium. She was brought to our hospital by ambulance. The abdomen was rigid with muscle guarding. Computed tomography (CT) of the abdomen revealed retention of barium in the sigmoid colon, with free air at its periphery. Upon diagnosis of pan peritonitis related to perforation of the digestive tract, emergency partial sigmoidectomy and colostomy were performed on the same day. The patient recovered uneventfully and was discharged on postoperative day 15. Colostomy closure was performed 6 months after the first surgery. Case 2: A 66-year-old woman presented with abdominal pain on the day after UGIS with barium. She was brought to our hospital by ambulance. The abdomen was rigid with muscle guarding. Abdominal CT revealed barium outflow into the abdominal cavity, and free air at its periphery. Upon diagnosis of pan peritonitis related to perforation of the digestive tract, emergency partial sigmoidectomy and colostomy were performed on the same day. Postoperatively, the patient received antimicrobial therapy for protracted fever, and was discharged on postoperative day 24.