Retained Barium but not Gold Caused Delayed Appendicitis: A Case Report

Authors

  • Guo-Bao Wang Tongji Hospital, Tongji University School of Medicine, Shanghai, China
  • Pengdu Cai Shanghai Yosemite Clinic & Hospital, Shanghai, China
  • Junxi Xue Shanghai Yosemite Clinic & Hospital, Shanghai, China
  • Priya Pahilajani Shanghai Yosemite Clinic & Hospital, Shanghai, China
  • Geng Yang Shanghai Yosemite Clinic & Hospital, Shanghai, China
  • Keying Song Shanghai Yosemite Clinic & Hospital, Shanghai, China

DOI:

https://doi.org/10.3941/jrcr.5374

Abstract

Background: Delayed appendicitis caused by “metallic” fecaliths is clinically rare, with a few reported cases. This case is from an Asian patient who consumed edible gold-leaf food and also had a history of yearly upper gastrointestinal barium meal fluoroscopy investigation. In order to identify the content in the fecaliths, samples were sent for Energy Dispersive X-ray Spectroscopy (EDX) for analysis. Case presentation: A 61-year-old, Chinese female presented with suspected appendicitis and was admitted for treatment. CT revealed four 5mm metal density objects (CT value 2000-3000 Hu) within the cavity. The surgery proceeded smoothly. After surgery, the specimen was cut open longitudinally and 2-soft granular fecaliths stuck in the lumen were seen. Immediate postoperative abdominal X-ray showed the other 2 high density nodules which had fallen into the ascending colon. The abdominal X-ray was repeated in the 1-week postoperative follow-up, which revealed no abnormal findings, indicating the remaining 2 foreign bodies had been passed out though normal defecation. Conclusion: Results of the EDX indicated the primary component to be barium oxide (BaO 54.518%), followed by silicon (SiO2 25.064%), calcium (CaO 10.583%), and sulfur (SO3 6.282%), with no presence of gold elements (Au 0.000%). The results confirmed that the fecaliths weren’t gold but barium. Barium appendicitis should be paid attention to in clinical practice.

During the surgery, an emergency laparoscopic appendectomy was performed.

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Published

2024-06-30

Issue

Vol. 18 No. 6 (2024)

Section

Gastrointestinal Radiology

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