To the Editor.—Recently, we saw a 42-year-old woman with acute gangrenous appendicitis with perforation. Roentgenograms showed residual barium within the appendix from an upper gastrointestinal x-ray series performed 11 months previously (Figure). Careful review of the literature disclosed only 11 reported cases of "barium appendicitis," five with gangrene and perforation.1
Current studies have shown that appendiceal barium retention is a very common finding after barium studies (particularly barium enemas).2 On occasion, we have personally observed persistent appendiceal barium enema in a patient for several weeks, without any untoward sequelae. Most of the reported patients with "barium appendicitis" have had appendiceal retention for months.
Because of the extreme rarity of this apparent complication, this should not enter into any decision as to whether or not a barium study is to be performed. Also, we would not recommend doing elective appendectomies on patients in whom barium is retained in