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Barium is still widely used in developing countries for gastrointestinal investigation because it is cheap and relatively safe. Most institutions however favour low-osmolar non-ionic contrast media for performance of childhood diagnostic enemas. These are relatively expensive and many developing countries reserve their use for cases where perforation is suspected. We present a case where barium leaked into the peritoneum during an enema investigation where no initial features of perforation were present. The added unique complication of barium entering the thoracic lymphatic system was noted. This complication was not found in a review of current literature.

Barium peritonitis with barium entering the lymphatic system