Non-operative management of barium peritonitis: a case report

TL;DR

A patient with barium peritonitis was successfully treated without surgery, suggesting conservative management can work in stable cases.

Contribution

This case report presents a rare instance of successful non-surgical treatment of barium peritonitis.

Findings

Conservative management with antibiotics and drainage resolved barium peritonitis without surgery.

The patient remained stable and asymptomatic during follow-up after conservative treatment.

The case suggests reconsidering barium-based contrast agents in high-risk patients.

Abstract

Barium peritonitis is a rare but serious complication caused by leakage of barium sulfate into the peritoneal cavity during gastrointestinal contrast studies. It carries high mortality and often necessitates surgical intervention. A 33-year-old female developed chemical peritonitis following a barium loopogram performed during her ileostomy reversal workup. Imaging revealed pneumoperitoneum and intra-abdominal collections due to barium spillage. Despite radiological findings, she remained clinically stable with only localized symptoms. Conservative management was pursued with intravenous antibiotics, hydration, analgesia, and CT-guided drainage. Surgery was avoided due to her stable clinical status and normal inflammatory markers. She recovered completely without in-hospital complications and remained asymptomatic on follow-up. This case demonstrates that conservative management of barium peritonitis is a viable option in selected stable patients. It also highlights the need to reconsider the use of barium-based contrast agents in favor of safer alternatives, especially in high-risk individuals.

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