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images in clinical medicine Lindsey R. Baden, M.D., Editor

Barium Concretion Causing Obstipation B


Nirav Thosani, M.D., M.H.A. Stanford University Stanford, CA

[email protected]

David S. Wolf, M.D. University of Texas Health Science Center at Houston Houston, TX


39-year-old woman with a history of severe scleroderma presented to the emergency department with nausea, vomiting, abdominal pain, and obstipation of 2 days’ duration. Seven days earlier, she had undergone an outpatient upper gastrointestinal series with barium contrast for diagnostic workup of dysphagia and abdominal pain. In the emergency department, an abdominal radiograph showed obstruction of the colon resulting from a 5-cm barium concretion in the proximal sigmoid colon (Panel A). The patient was transferred for surgical management. During flexible sigmoidoscopy, a barium concretion, causing luminal obstruction was seen (Panel B). The mass was broken into small pieces with a high-pressure water jet and biopsy forceps (video), and the lumen was restored. The patient’s symptoms resolved, and she was discharged home 2 days after endoscopy. Barium impaction has a known association with disorders causing intestinal dysmotility.

DOI: 10.1056/NEJMicm1313574 Copyright © 2014 Massachusetts Medical Society.


n engl j med 371;6

august 7, 2014

The New England Journal of Medicine Downloaded from on October 27, 2015. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.

Images in clinical medicine. Barium concretion causing obstipation.

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