Background: The barium enema examination (BEE) is an important diagnostic study and considered to be safe without adverse effects. Perforation of the bowel is rare but is the most frequent complication of BEE and can be life-threatening.
Study design: We report four cases of barium extravasation due to BEE treated at our institution, three rectal perforations and one perforation in the descending colon.
Results: The four patients underwent surgery because signs of peritonitis developed. Two of them recovered and two died from multiple organ failure.
Conclusion: Perforation of the colon and rectum during BEE constitutes a surgical emergency in most cases. Prompt recognition and management are vital in decreasing morbidity and mortality.