The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic
trauma or disease is more likely to perforate during an
enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the
enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a
stricture,
neoplasm, inflamed rectum, or
colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with
electrocautery makes the bowel more vulnerable to
rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term
steroid therapy, and in disease states including
neoplasm,
diverticulitis,
inflammatory bowel disease, and
ischemia. Intraperitoneal perforation leads to a severe, acute
peritonitis with intravascular volume depletion. The ensuing
shock may be rapidly fatal. Prompt fluid replacement and
laparotomy are essential. If the patient survives the initial
shock and
sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in
pain,
sepsis,
cellulitis,
abscess, rectal
stricture, or
fistula. Intramural extravasation often forms a persistent submucosal
barium granuloma which may ulcerate or be mistaken for a
neoplasm. The most dramatic complication of barium enema is venous intravasation of
barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to
trauma from the
enema tip or retention balloon, mucosal
inflammation, or misplacement of the tip in the vagina.
Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic
septicemia. Other less common complications include
barium impaction,
water intoxication,
allergic reactions, and
cardiac arrhythmias. Preparatory laxatives and cleansing
enemas have been implicated in some instances of
dehydration, rectal
trauma,
water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)