Perforation of the rectum and sigmoid colon during barium‐enema examinationManagement and prevention
作者:
Robert Fry,
Eli Shemesh,
Ira Kodner,
James Fleshman,
Alan Timmcke,
期刊:
Diseases of the Colon & Rectum
(OVID Available online 1989)
卷期:
Volume 32,
issue 9
页码: 759-764
ISSN:0012-3706
年代: 1989
出版商: OVID
关键词: Barium enema;Perforation;Iatrogenic colonic;Colon;Rectum
数据来源: OVID
摘要:
&NA;Perforation of the rectum or sigmoid colon complicated 5 of 2200 barium‐enema examinations performed during a 4‐year period. Three patients with rectal perforations manifested by air extravasation were successfully treated with intravenous antibiotics and complete bowel rest. Two patients with barium extravasation were treated with immediate operation and colostomy. All five patients recovered. Perforation was found to be associated with a rectal stricture due to ulcerative colitis, a rectal cancer, an incarcerated inguinal hernia, fulminant ulcerative colitis, and a normal colon in an elderly patient. To determine the pressure in the rectum that could potentially be generated during a barium‐enema examination, the pressures created by a standard barium delivery set were measured, using 1‐meter columns of water, 25 percent diatrizoate sodium (Hypaque®), 20 percent barium, and 80 percent barium. The columns generated pressures of 70, 85, 95, and 120 mm Hg respectively. Squeezing the delivery bag increased the pressure 21 to 79 percent or a maximum of 55 mm Hg. Colorectal perforation during barium‐enema examination that was not accompanied by barium extravasation could be successfully treated nonoperatively. The associated pathology and our studies of pressures generated during a barium‐enema examination allow us to suggest that the incidence of colorectal perforation during barium‐enema radiography can be reduced by 1) performing proctoscopy prior to barium enema, 2) avoiding the use of the rectal balloon in patients with known rectal lesions, 3) avoiding barium studies in patients with active colitis, 4) avoiding generation of pressure greater than that created by a column of barium suspension of one meter, and 5) using a lower concentration of barium when possible.
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