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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 (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.