barium swallow? or gastrografin?

[europeman]

Is it true that if you have an esophageal tear that leaking barium has more morbidity than gastrografin?

I'm assuming that's why most do gastrografin followed by barium swallow.

What is the morbidity?

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[butterfly0660]

Barium causes an intense inflammatory response if it extravasates into the mediastinum or the peritoneal cavity. I took care of a lady who had a barium swallow with a perforated duodenal ulcer and she had permanent GI dysmotility with a frozen abdomen and eventually died from the barium extravasating into her peritoneal cavity. This is despite her being taken immediately for a laparotomy and every attempt made to irrigate out all the barium.

 

[GreatSaphenous]

If you fear a leak use gastrograffin because of barium's risk of massive peritonitis or mediastinitus. But if you fear aspiration, use barium since gastrograffin is associated with bad pneumonitis.

Be strong.
Walk the line.
Go back to your Cavatappi,
I remain the Great Saphenous!!!

 

[thedrjojo]

I know you use Gastrograffin for fear of abdominal leaks because of the barium peritonitis, but i thought if you feared mediastinal/pleural leak, you are suppose to use barium.

 

[otopico]

Up until today, I had it etched in my mind that if you are interested in aspiration use barium. If you are interested in ruling out leak you use gastrograffin for the reasons listed in the prior posts. At the institutions I have trained at, if there is concern for perforation then usually gastrograffin is used followed by barium if the gastrograffin is negative. We currently have a patient with concern for perforation and CT surgery (resident, then fellow, then staff) said to use BARIUM...the controversy continues.