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Case of the Week 342

What's the most likely diagnosis?

  • 48 year-old with abdominal pain following a test

Maximum Intensity Projection Image (MIP) from a CT Urogram

  1. Meconium peritonitis
  2. Multiple gunshot wounds
  3. Thorotrast administration
  4. Extraluminal barium
  5. Old TB

Additional Image - Conventional abdominal radiograph on another patient


Additional Image


Conventional abdominal radiograph on
another patient with same problem




4. Extraluminal barium from perforation during barium enema



More (Click Discussion Tab)

Barium Perforation into the Peritoneal Cavity

General Considerations

  • Barium sulfate is used as a contrast agent for, amongst other things, barium enema examinations
  • It is inert, radiopaque and provides excellent anatomical detail
  • On very rare occasions, a perforation may occur allowing the administered barium to leak into the peritoneal cavity
  • Barium peritonitis may occur from an inflammatory reaction
    • Intestinal content, e.g. fecal material, which also spills into the peritoneal cavity at the same time may play a role in producing sepsis
    • “Sterile” barium contamination will still cause peritonitis, but it may not be accompanied by the same degree of sepsis

    More ...


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