Williams S M, Harned R K
Department of Radiology, University of Nebraska Medical Center, Omaha.
Curr Probl Diagn Radiol. 1991 Jul-Aug;20(4):123-51. doi: 10.1016/0363-0188(91)90017-v.
The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed.(ABSTRACT TRUNCATED AT 400 WORDS)
钡灌肠是一种对结肠安全且准确的诊断检查，但在极少数情况下可能会出现并发症。其中许多并发症可通过使用合适的设备并严格注意操作技术来预防。当并发症发生时，迅速识别和处理对于降低发病率和死亡率至关重要。肠道穿孔是最常见的严重并发症，约0.02%至0.04%的患者会出现。很少有结肠仅因跨壁压力过大而破裂的情况。然而，因医源性创伤或疾病而变弱的结肠在灌肠时比正常健康的肠道更易穿孔。灌肠头或保留气囊导致的直肠黏膜或肛管损伤可能是钡灌肠穿孔最常见的创伤性原因。在狭窄、肿瘤、直肠发炎或结肠造口处对保留气囊进行充气尤其危险。近期进行的深部活检或电灼息肉切除术会使肠道更易破裂。老年患者、接受长期类固醇治疗的患者以及患有肿瘤、憩室炎、炎症性肠病和缺血等疾病的患者，其肠壁的抗张强度会受损。腹腔内穿孔会导致严重的急性腹膜炎并伴有血管内容量减少。随之而来的休克可能迅速致命。迅速进行液体补充和剖腹手术至关重要。如果患者在最初的休克和败血症中存活下来，后期可能会因腹腔内致密粘连而出现并发症。腹膜外穿孔通常危害较小，但可能导致疼痛、败血症、蜂窝织炎、脓肿、直肠狭窄或瘘管形成。壁内渗漏常形成持续性黏膜下钡剂肉芽肿，可能会发生溃疡或被误诊为肿瘤。钡灌肠最严重的并发症是钡剂静脉内渗漏。幸运的是，这种情况非常罕见，因为它可能会立即致命。大多数病例归因于灌肠头或保留气囊造成的创伤、黏膜炎症或灌肠头误置入阴道。钡灌肠后多达23%的患者会出现菌血症，在极少数情况下，可能会导致有症状的败血症。其他不太常见的并发症包括钡剂嵌塞、水中毒、过敏反应和心律失常。在某些脱水、直肠创伤、水中毒和穿孔病例中，涉及到了准备用的泻药和清洁灌肠。仔细审查检查指征、既往X光片和临床病史，将识别出许多并发症风险较高的患者，以便采取适当的预防措施。（摘要截选至400字）
