A barolith consists of inspissated barium associated with feces seen rarely, after barium studies for imaging the gastrointestinal tract. Since barium sulfate is insoluble, it can in rare cases precipitate in the bowel, sometimes becoming symptomatic with a significant delay (from few weeks to up to 2 years) in presentation after the radiologic study 3.
Depending on its location in the gastrointestinal system, it may cause colonic obstruction, intussusception, volvulus, ulceration, perforation or even appendicitis 1-3.
- advanced age
- dehydration / electrolyte imbalances
- colonic luminal narrowing
- impaired colonic motility (due to drugs or systemic diseases)
Conservative management relies on the use of laxatives, however surgery is commonly necessitated. Endoscopic dissolution can offer an alternative, minimally invasive approach for patients when conservative therapy proves to be futile, or when surgery is considered high-risk or contraindicated 1-2.
Symptomatic barolith-formation is a potentially serious complication often warranting invasive, surgical management. Thus, efforts must be focused on preventing it by advising patients to drink ample amount of fluids, use laxatives, and report to their physician if the cessation of bowel movements occurs after a barium contrast study 3.
- 1. M. A. Kurer, C. Davey, S. Chintapatla. Intestinal obstruction from inspissated barium (Barolith): a systematic review of all cases from 1950 to 2006. (2008) Colorectal Disease. 10 (5): 431. doi:10.1111/j.1463-1318.2008.01503.x - Pubmed
- 2. Ince, V., Isik, B., Koc, C., Baskiran, A. & Onur, A. Barolith, a rare cause of acute appendicitis: a case report. Ulus Travma Acil Cerrahi Derg 19, 86–88 (2013).
- 3. Shaughnessy GF, Cho P, Francis DL. A Rare Complication of a Barium-Contrast Study. (2015) Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 13 (7): e67-8. doi:10.1016/j.cgh.2014.12.029 - Pubmed