Barium granuloma of the rectum

Summary and Conclusions

Clinical and experimental evidence indicates that barium sulfate causes minimal foreign-body reaction and generally is well tolerated when injected into the lungs, peritoneal cavity, and subcutaneous and retroperitoneal tissues. That this is also true when it is injected accidentally into the wall of the rectum during administration of barium enemas is revealed by a review of the 15 cases reported in medical literature and our two cases.

Depending on the degree of bacterial contamination, host resistance, and the site and mechanics of injection, barium introduced into the wall of the rectum may present as perianal or retrorectal abscesses which require drainage, or as ulcerated or nonulcerated tumors of the rectal wall. In the latter instances, only biopsy is required for diagnosis, and this is well tolerated. Attempts to eliminate the barium from the tissues by surgical means are futile and unnecessary.

Barium granuloma of the rectum can be avoided by care and diligence while introducing tubes into the rectum prior to administration of barium enemas, by avoiding excessive pressure in the rectum when a balloon is used, and by avoiding administration of barium enemas soon after biopsy of the rectal mucosa.