Pneumomediastinum after double-contrast barium enema examination: a sign of colonic perforation

Rectal Perforations After Barium Enema: A Review

“…In this context inflammatory bowel diseases (ulcerative colitis, Crohn's disease, diverticulitis), ischemic colitis, previous radiotherapy in the colorectal area, colonization by intestinal parasites, recent biopsies or polypectomies, old age, and the existence of fistulas or fissures make patients more susceptible to perforation. 4,[27][28][29][30][31] Chronic steroid therapy also is suggested to be associated with a higher risk for perforation. 32 Besides tumors, colorectal stenosis, spasms, and fecal impaction should be mentioned as additional causes of obstruction.…”

“…3). 24,29,31,57 This makes fluoroscopic detection difficult. Air may extend into the mesentery of the bowel, the retroperitoneal area along the psoas muscles, perirenal, or even into the mediastinum and neck and face area.…”

“…Air may extend into the mesentery of the bowel, the retroperitoneal area along the psoas muscles, perirenal, or even into the mediastinum and neck and face area. 19,29,31,43,[58][59][60] The diagnosis is frequently made in retrospect on delayed abdominal or chest x-rays or clinically. 31 In case of barium extravasation, migration via lymphatics to other parts of the reticuloendothelial system has been described.…”

“…19,29,31,43,[58][59][60] The diagnosis is frequently made in retrospect on delayed abdominal or chest x-rays or clinically. 31 In case of barium extravasation, migration via lymphatics to other parts of the reticuloendothelial system has been described. 30 Although Peterson et al 43 described the possibility of perforations caused by barium enema into adjacent viscera (e.g., the bladder), he stated that this type of perforation has never been reported.…”

Iatrogenic perforation at colonic imaging

“…The clinical picture can vary from retroperitoneal emphysema to frank barium peritonitis [89]. Four mechanisms of colonic injury are suggested, namely direct trauma from Iatrogenic perforation at colonic imaging the catheter tip [90,91], overinflation of the rectal balloon, recent colonic instrumentation ⁄ biopsy [92][93][94] and the presence of mucosal disease [84,94]. Inflation of a retention balloon in a stricture or inflamed rectum is also hazardous.…”