Images in Clinical Medicine
Barium Impaction in the Sigmoid Colon
N Engl J Med 1997; 337:1278October 30, 1997
- Article
Figure 1 A 54-year-old woman with lung cancer presented with severe abdominal pain and bilious vomiting. She had had a diagnostic barium small-bowel follow-through 10 days earlier for nausea and vomiting. She had undergone a partial left lobectomy in 1987 and 1992 and a Billroth II gastric resection many years earlier for peptic ulcer disease. On examination she was dehydrated and had diffuse abdominal tenderness but no peritoneal signs. Abdominal plain films showed inspissated barium (arrows in Panels A and B) in the sigmoid colon. Efforts to break up the impaction manually failed. Flexible sigmoidoscopy was attempted, but a solid barium fecalith was encountered that occluded the entire lumen; there were ulcerations in the mucosa around the fecalith. Approximately two hours after the endoscopic procedure, the patient was found to have free air on a plain abdominal film and she was taken immediately to the operating room. A sigmoid colectomy with a Hartmann's pouch was performed, and the impacted barium fecalith was removed. The patient recovered uneventfully.
W. Michael McDonnell, M.D.
Western Washington Medical Group, Everett, WA 98201Frank Jung, M.D.
Veterans Affairs Medical Center, Ann Arbor, MI 48105- Citing Articles (2)
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