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\begin{document}

\title{Barium Appendicitis}



\author[1]{Daisuke Omura}%
\author[2]{Naoko Yunoki}%
\author[1]{Yuki Otsuka}%
\author[1]{Yasuhiro Nakano}%
\author[1]{Hideharu Hagiya}%
\author[3]{Fumio Otsuka}%
\affil[1]{Okayama University Hospital}%
\affil[2]{Akaiwa Medical Assosiation Hospital}%
\affil[3]{Okayama Daigaku - Shikata Campus}%


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  \date{May 10, 2024}


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Clinical Images:

\textbf{Barium Appendicitis}

Daisuke Omura, M.D., Ph.D.\textsuperscript{1, 2)}, Naoko Yunoki, M.D.,
Ph.D.\textsuperscript{2)}, Yuki Otsuka, M.D.\textsuperscript{1)},
Yasuhiro Nakano, M.D., Ph.D.\textsuperscript{1)}, Hideharu Hagiya, M.D.,
Ph.D. \textsuperscript{1)} and Fumio Otsuka, M.D.,
Ph.D.\textsuperscript{1)}

\textsuperscript{1)} Department of General Medicine, Okayama University
Graduate School of

Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; and

\textsuperscript{2)} Department of Internal Medicine, Akaiwa Medical
Assosiation Hospital, Akaiwa, Japan

\textbf{Corresponding author:} Daisuke OMURA, M.D., Ph.D.

Department of General Medicine, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho,
Kita-ku, Okayama 700-8558, Japan.

Tel.: +81-86-235-7342; Fax: +81-86-235-7345

E-mail: me20011@s.okayama-u.ac.jp

\textbf{Acknowledgement:} None to report.

\textbf{Conflict of Interest:} We have no financial relationships to
disclose.

\textbf{Key words:} appendicitis; barium

\textbf{Key Clinical Message:} We have presented a case of barium
appendicitis, which is a rare complication of barium enema studies.
Barium sulfate is used widely for gastrointestinal radiographic studies
and is associated with few complications. Clinicians need to be fully
aware of this complication. (41 words)

\textbf{Authors' Contribution:} DO: wrote the first draft and managed
all of the submission process. NY, YO, and YN: supervised clinical
management of the patient. HH and FO: contributed to clinical management
of the patient and revised the manuscript.

\textbf{Text:}

A previously healthy 42-year-old male was admitted to our hospital with
a complaint of abdominal pain for a day. The patient's vital signs were
within normal range, and he had no physical findings other than
tenderness in the upper right abdomen. Blood analysis showed elevations
of C-reactive protein (5.4 mg/dL). Computed tomography revealed high
density in the appendix (\textbf{Fig A} ), and the patient was diagnosed
with appendicitis. Subsequent interviews revealed that the patient was
taking barium for a medical examination three days before his visit. The
patient underwent antibiotic treatment for barium appendicitis.

Barium remains in the appendix for more than 72 hours in only 8\% of
patients (1), and in a small number of these patients, the remaining
barium obstructs the lumen of the appendix and causes appendicitis (2).
Since barium is widely used in gastric cancer screening in Japan, the
diagnosis and recognition of barium appendicitis is particularly
valuable.

\textbf{References}

1. Yu-Jen Fang, Hsiu-Po Wang, Cheng-Maw Ho, Kao-Lang Liu. Barium
appendicitis. Surgery . 2009 Nov;146(5):957-8. 2. Hideki Katagiri, Alan
Kawarai Lefor, Tadao Kubota, Ken Mizokami. Barium appendicitis: A single
institution review in Japan. World J Gastrointest Surg. 2016 Sep
27;8(9):651-655.

\textbf{Hosted file}

\verb`Barium Appendicitis picture -.pptx`  available at \url{https://authorea.com/users/332755/articles/517868-barium-appendicitis}

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