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June 3, 1983

Rectal Injury During Barium Enema Examination

Author Affiliations

University of Arizona Health Sciences Center Tucson

JAMA. 1983;249(21):2893. doi:10.1001/jama.1983.03330450025019

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To the Editor.—  In TOPICS IN RADIOLOGY (1982;248:1375), Walker and colleagues describe massive extravasation of extraperitoneal air in an elderly woman after double-contrast barium enema (DCBE) examination. Although the authors note a low reported incidence (0.02%) of rectal injury from DCBE examination and allude to wide variations in quantities of extraperitoneal and intraperitoneal air that may accumulate, they conspicuously underemphasize the potential lethality of this complication. Because these patients have fortuitously been thoroughly cleansed of stool by preexamination enemas and laxatives, such injuries may be treated expectantly. Nevertheless, as the following case report exemplifies, rectal tear from DCBE examination endangers life and may require prompt aggressive treatment.

Report of a Case.—  A 51-year-old asymptomatic woman underwent DCBE examination for follow-up of a benign polyp removed from the sigmoid colon three years earlier. Toward the end of the examination, the retention balloon suddenly ruptured, expelling the catheter. Although no immediate discomfort