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“High absorption area in the pelvis”

Published:November 23, 2020DOI:https://doi.org/10.1016/j.ejim.2020.11.008

      1. Case description

      A 42-year-old man presented to our emergency room with epigastric pain. He had undergone a barium examination 6 weeks previously for gastric cancer screening. He was apyrexial. Physical examination revealed slight tenderness in the epigastric region and McBurney's point. However, there were no signs of peritoneal irritation such as percussion tenderness. A plain radiographic study of the abdomen revealed high-absorption areas in the pelvis (Fig. 1A). Abdominal computed tomography revealed metal artifact-like findings in the appendix (Fig. 1B and Fig. 1C).
      Fig. 1
      Fig. 1(A): X-ray of the abdomen showing high-absorption areas in the pelvis (arrows). (B and C): Abdominal computed tomography showing metal artifact-like findings in the appendix (arrows).
      Fig. 1
      Fig. 1(A): X-ray of the abdomen showing high-absorption areas in the pelvis (arrows). (B and C): Abdominal computed tomography showing metal artifact-like findings in the appendix (arrows).

      2. What is the diagnosis?

      Barium appendicitis.

      3. Discussion

      Barium appendicitis was suspected, and a laparoscopic appendectomy was performed. Surgery revealed a swollen appendix and solidified barium in the appendix.
      Barium is usually excreted naturally from the body after barium examination [
      • Maglinte D.D.
      • Bush M.L.
      • Aruta E.V.
      • et al.
      Retained barium the appendix: diagnostic and clinical significance.
      ]. It rarely remains in the body as in the present case. The period from barium examination to onset can vary from hours to months [
      • Katagiri H.
      • Lefor A.K.
      • Kubota T.
      • et al.
      Barium appendicitis: a single institution review in Japan.
      ]. Barium appendicitis cannot be ruled out because the patient has not recently undergone barium examination.

      Declaration of Competing Interest

      I declare no conflicts of interest associated with this manuscript.

      References

        • Maglinte D.D.
        • Bush M.L.
        • Aruta E.V.
        • et al.
        Retained barium the appendix: diagnostic and clinical significance.
        AJR Am J Roentgenol. 1981; 137: 529-533
        • Katagiri H.
        • Lefor A.K.
        • Kubota T.
        • et al.
        Barium appendicitis: a single institution review in Japan.
        World J Gastrointest Surg. 2016; 8: 651-655