A 38-year-old woman was referred after inadvertent insertion of an enema tube into the vagina with instillation of barium. A barium enema had been requested because of abdominal pain following drainage of a perianal abscess and repair of anal fistula.
The patient presented with abdominal pain and tenderness. A plain X-ray of the abdomen showed free barium inside the peritoneal cavity (Figure). After hydration and administration of prophylactic antibiotics for 48 hours, the patient was discharged free of symptoms.
Inadvertent barium insertion into the female genital tract is rare but potentially lethal. In seven of nine reported cases of accidental barium application into the vagina, the patients died because of contrast embolization and vagal shock.
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Consent to publish this image has been obtained from the patient.
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© 2013 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.
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