Asymptomatic Colonic Diverticulosis With Sigmoid Colon Perforation and Barium Peritonitis After an Upper Gastrointestinal Series: A Case Report.

Upper gastrointestinal series (UGIS) remains an important modality for gastric cancer screening; however, intestinal perforation after this examination, although rare, can result in life-threatening barium peritonitis. We report a case of sigmoid colon perforation after UGIS in a 47-year-old woman with previously asymptomatic colonic diverticulosis and discuss its implications for preexamination risk assessment. She developed abdominal pain two days after undergoing UGIS during a routine health checkup. Computed tomography showed free air and intraperitoneal barium leakage. Emergency surgery revealed sigmoid colon perforation with a barium fecalith adjacent to the perforation site. Partial sigmoid colectomy, diverting transverse colostomy, extensive peritoneal lavage, and drainage were performed. Postoperatively, she developed septic shock and required intensive care and continuous hemodiafiltration; however, she gradually recovered and was discharged on postoperative day 40. Histopathological examination suggested diverticular perforation without malignancy. In this case, asymptomatic colonic diverticulosis may have reduced colonic wall compliance, and localized pressure from the barium fecalith may have triggered perforation. Given the increasing prevalence of colonic diverticulosis, preexamination risk assessment before UGIS should consider asymptomatic diverticulosis as well as treated diverticulitis.