Barium Enema Leads to Perforation of Vagina

Case Overview

Client is 79 yr old woman who was undergoing a barium enema administered by a technician. During procedure, the tech/nurse rolled her over to take an x-ray and the tube fell out of her rectum. The tech/nurse reinserted it, but in doing so perforated through her vagina and into the stomach cavity. Barium continued to be pumped into patient. This was discovered so they stopped the procedure. Drs. repaired the vaginal damage and opened up her abdomen in an effort to flush out the barium with a saline solution. She was then returned to ICU. She had another laparotomy the next day to further try to clean out the barium. Doctors told her that barium is still present in her stomach cavity, around her colon, liver and intestines. They have told her that they do not know the long term consequences of the presence of barium.

Issue

Was it substandard for the nurse/tech to perforate her vagina and go into abdominal cavity while giving a barium enema? Should they have realized it before they pumped a lot of barium into the wrong place? Finally what is long and/or short term effect of the continued presence of barium in the abdominal cavity?

MEDQUEST EXPERT RESPONSES:

It is clearly substandard to perforate through the rectum through the vagina into the abdomen. Most likely the tube was inserted into the vagina and perforated the vagina into the abdominal cavity. The long term issue of barium inside the abdomen of an 74 year old is unknown. They should have noted the extravasation during the instillation of the barium rather quickly realizing they were in the wrong place. Obvious departure with perforation and failure to notice.
Dr SL – Gastroenterologist

Clear departure. However it would be hard to blame subsequent pain and obstruction on the retained barium, especially in a patient who underwent surgical procedures to deal with the spill. Surgery will cause adhesions which can cause pain and obstruction. I don’t know specifically about the long-term effects of free floating barium in the peritoneal cavity. I imagine it could cause inflammation (granulomatous) which might increase risk for pain and obstruction.
DR AH – Gastoenterologist