Barium peritonitis

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Barium peritonitis is a rare complication of gastrointestinal barium studies, and occurs when there is gastrointestinal tract perforation and spillage of barium contrast agent into the peritoneal cavity resulting in peritonitis, granuloma and stone formation .

Pathology

Barium sulfate in the peritoneal cavity is treated as a foreign body with resultant immune response that has two phases :

acute: chemical peritonitis occurs with development of large volume of exudative ascites; hypovolemic shock can subsequently develop
chronic: extensive fibrosis develops around barium with granuloma formation; adhesions and subsequent small bowel obstruction are common

Treatment and prognosis

Early laparotomy and washout/removal of barium has been shown to be beneficial. In the acute phase intravenous fluid replacement may be needed to counter the large volume of ascites and hypovolemia that can develop . Mortality is high at ~35% (range 20-53%), and is increased if there is concomitant bacterial peritonitis .