Retained barium n the appendix: diagnostic and clinical significance.

The significance of prolonged retention of barium in the appendix in an asymptomatic patient has been debated. Four patients, with retained barium in the appendix for several months after gastrointestinal barium studies, who then developed acute appendicitis, are reported and analyzed. Thirty-one patients who retained appendiceal barium longer than 72 hr after radiographic examination of the gastrointestinal tract were followed for over 1 year. No patient developed appendicitis. Five patients underwent abdominal surgery for other indications and there was no evidence of appendicitis. In 11 patients, who had abdominal radiographs 6 days to 4 months after detection of appendiceal barium, the barium had disappeared. The connotation of the term "barium appendicitis" as initially reported is questioned. Preliminary data in this report suggest that no causal relationship exists between prolonged retention of barium and future acute appendicitis and that normal appendices can expel barium in variable time periods. Etiologic connotation between prolonged appendiceal barium retention and future acute appendicitis should be erased. Retained barium in the appendix can be used as an acid in the precise radiographic diagnosis of acute appendicitis.