Fatal Rectal Perforation Following Double Contrast Barium Enema

Double-contrast barium enema (DCBE) is a widely used diagnostic tool for colorectal disorders, providing a relatively cheap and less invasive alternative to invasive procedures such as colonoscopy. Complications due to DCBE can be fatal in a small number of cases. Rectal perforations to the intra-peritoneal or retro-peritoneal space are the most severe and life-threatening complications where immediate diagnosis and treatment are essential. We report the case of a 72-year-old male admitted to the emergency department with dyspnea, altered mental status and swelling in the neck 15 minutes after DCBE. Upright chest X-ray revealed sub-diaphragmatic air with subcutaneous emphysema, and computed tomography revealed air in the deep neck tissue and abdominal cavity, accompanied by pneumothorax and pneumomediastinum. This case demonstrates the importance of chest pain, neck swelling and neurological symptoms after DCBE as signs of possible serious complications that should alert emergency physicians.