Fatal venous intravasation of barium during a barium enema.

Abstract

The barium enema examination is not always without risk. Once in a while a serious and occasionally even a fatal accident may occur as a result of this procedure. The following case represents an exceedingly unusual complication, in which the contrast medium in some unexplained manner entered the venous system and caused sudden death. Case Report A 73-year-old white woman was admitted to the Jewish Hospital on April 9, 1952, in a confused state. The history, obtained from relatives, indicated that one month prior to admission she had been studied at another hospital for about a week. A mass in the right lower abdominal quadrant had been found. Following a dilatation and curettage, a diagnosis of uterine fibroids had been made. After discharge from the hospital, the patient ran a febrile course, with a daily temperature elevation to 102°, and lost about ten pounds in weight. For these reasons she was admitted for study at our hospital. Physical examination revealed an emaciated, chronically ill, irrational, elderly white female. The chest was clear. A large, firm, smoothly outlined mass was felt in the right lower abdomen. Pelvic examination showed the cervix to be normal. The uterus was thought to be greatly enlarged, and was continuous with the lower abdominal mass. Rectal examination demonstrated a small hemorrhoidal tag, but no other hemorrhoids were felt and no intrinsic mass was palpable. Brown stool was noted on the gloved finger. No sigmoidoscopy was done. Roentgen examination of the chest disclosed moderate cardiac enlargement and evidence of a small amount of fluid at the left base. A plain film of the abdomen showed a large soft-tissue mass in the right lower quadrant and pelvis. Films of the bony structures revealed severe osteoporosis, with partial collapse of the bodies of the eleventh and twelfth dorsal and the second lumbar vertebrae, and destructive lesions in the ribs. The findings were interpreted as possibly representing metastases or multiple myeloma. It was decided to do a barium enema examination in order to study the relationship of the mass to the colon. The patient was quite disoriented on her arrival in the X-Ray Department for this procedure. A Bardex balloon catheter was inserted in the rectum by the technician, but the patient immediately expelled it. The catheter was reinserted by one of us (A. F.) and under fluoroscopic guidance the bulb was filled with air. It did not appear that an excessive amount of air was used, and the patient gave no sign of particular pain or discomfort. The barium suspension was then instilled. This seemed to be entering the rectum in the usual fashion, when suddenly some of the barium appeared to channel in multiple directions and then to sweep cephalad. The enema was instantly stopped.