術後膿胸を合併したバリウム腹膜炎の一例

The patient was a ４０-year-old woman. She visited our hospital because of sudden pain developing ４ days after upper gastrointestinal radiography with barium. Her abdomen showed board like rigidity. On the basis of abdominal radiography and computed tomography（CT）findings, we made a diagnosis of barium peritonitis. Emergency surgery was performed on the same day. A ３-cm diameter perforation was noted in the sigmoid colon. The perforated area had been plugged with fecal mass of a size larger than the fist. Purulent ascites, mixed with food residues, were noted in the peritoneal cavity, and the leaked barium had attached to the mesentery and intestine. Cleansing with about１０，０００mL warm physiological saline was carried out to remove these contaminants. Because postoperative inflammatory reactions persisted, thoracic and abdominal CT scans were obtained on the１０th hospital day ; they showed bilateral hydrothorax as well as residual barium and abscess under the left diaphragm. The patient was treated conservatively, but thoracic and abdominal CT scans obtained on the ４４th hospital day allowed a diagnosis of left empyema. On the same day, lavage and drainage of the empyema-affected area were carried out. This resulted in the alleviation of the postoperative inflammatory reactions. The residual barium under the left diaphragm was considered as the cause of the postoperative condition in this case. Upon detection of barium peritonitis, it is essential to diagnose the underling condition as soon as possible and to completely（leaving no residual barium）and immediately remove the barium.