We thank Dr Nathan for furthering our knowledge of the complications of the double-contrast barium enema (DCBE) examination with his case report, which seems to be unique in the literature. A contained intramural perforation that later showed extravasation of barium has been reported with the single-contrast barium enema (BE) examination.1Dr Nathan raises two questions that cannot yet be answered definitively: (1) How common are rectal perforations during DCBE examination? (2) What treatment is required?In regard to the first question, there are as yet too few published data to determine the risk of rectal perforation during DCBE examination relative to the better-defined risk during the BE examination. Indeed, the two-in-10,000 figure we cited in our article is the only one available in the English-language literature. In comparison, the frequency of rectal perforation during conventional BE examination was six in 20,000 (ie, one in 3,333) in the largest
Walker HC, Nivatvongs S, Gedgaudas E. Rectal Injury During Barium Enema Examination-Reply. JAMA. 1983;249(20):2780. doi:10.1001/jama.1983.03330440020021
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