Barium and Perotinitis

[Docgeorge]

I know I'm cross posting with the thread in surgery but I wanted to get a radiologists prespective.

I you somehow manage to get Barium into the peritonium will it case perotinits?

Second if you were doing a esophegeal study and you suspected a perf would you use water soluble contrast or barium?


Thanks in advance for your replies

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[ckent]

My understanding is that you should use water soluable contrast if you suspect a perforation but are unable to see any free air or if you just want to quantify it because the other type of contrast will cause a worsening of a chemical perotinitis.

 

[Whisker Barrel Cortex]

Barium is irritating to the peritoneum and can cause barium peritonitis and thus should not be used if bowel perforation is suspected. This is a somewhat controvertial point in that many people believe it is the bowel contents that are actually causing the peritonitis.

However, for suspected esophageal perforation it is usually not as contraindicated. Barium in the pleural space is not as bad as in the peritoneum in my experience. The way we usually do it is to use a water soluble contrast first. If no visible perf, then we try barium, since this has a higher sensitivity and is much more visible on flouro. I did a recent case where initial water soluble trial did not show leak, but barium did. The patient did fine with a small amount of barium in the pleura. When doing esophageal studies, you also need to consider the risk of aspiration. Most water soluble contrasts have very high osmoles and will cause significant aspiration pneumonitis (can lead to ARDS) wheras barium is inert in the lung. We usually dilute the water solubles with water if aspiration as well as perforation is a possiblity.

 

[Docgeorge]

thanks for takeing the time to reply