Intestinal obstruction from inspissated barium (Barolith): a systematic review of all cases from 1950 to 2006

Abstract

Objective: Having encountered a case of large bowel obstruction secondary to a barolith and successfully treated it using colonoscopic dissolution, we systematically reviewed all cases of barolith obstruction to appreciate its incidence and explore its methods of treatment.

Method: A literature search was carried out in the databases British Nursing Index, Cinahal, Embase, Medline, and Pub Med. There was no restriction placed on language of publication in the search.

Results: There were 22 reports describing a total of 31 cases. About one third of the reported cases were successfully treated with conservative measures including the use of laxatives. Significantly, surgery was performed in nearly half of the patients. Interestingly, endoscopic dissolution was attempted in only 3 cases and it was successful in all of them.

Conclusion: This systematic review reveals several reported cases of barolith obstruction from 1950-2006. Only three case reports described colonoscopic dissolution. In our institute, we have recently encountered a case of large bowel obstruction secondary to a barolith and we successfully treated it using colonoscopic dissolution. Given the absence of guidelines to treat barolith induced obstruction, we are of the opinion that should a barolith obstruction occur, in the absence of perforation or ischaemic bowel, endoscopic dissolution by an experienced endoscopist under general anaesthetic offers a safe, effective, and minimally invasive method of relieving the obstruction. Should this fail surgery is indicated.