Respiratory failure from an upper gastrointestinal series

Naseem Helo; Daniel Hoss; Mark Girguis

doi:10.1183/09059180.00002214

A 67-year-old male was brought to hospital (Linda University Medical Center, Loma Linda, CA, USA) after being hit by a car. The patient underwent surgery for a fractured acetabulum. The post-operative course was complicated by 7 days of ileus. An upper gastrointestinal (GI) series (i.e. barium swallow) with small bowel follow-through was requested. There were no immediate complications during the upper GI series. The supine abdominal radiograph at 8 h post-upper GI series (fig. 1) showed relatively normal lungs and contrast within the stomach and proximal small bowel. 15 h after the upper GI series, the patient complained of shortness of breath with a respiratory rate of 14 breaths·min⁻¹ and an arterial oxygen saturation measured by pulse oximetry of 99%. The patient was reassured. The supine abdominal radiograph at 16 h post-upper GI series (fig. 1) showed consolidation within the right lung. A contrast chest computed tomography scan was then performed (fig. 2) and showed hyperdense round irregular foci within the lung with surrounding consolidation. The densities within the lung represented aspirated barium contrast after the upper GI series while the patient was in his room. Due to the severe ileus, the contrast agent did not pass through the stomach and remained at a location susceptible to aspiration. The patient went on to suffer acute respiratory failure as a result of acute pneumonitis and eventually had a tracheostomy tube inserted. This demonstrates the importance of aspiration precautions for patients with ileus.

Figure 1.

Supine abdominal radiograph from a 67-year-old male a) 8 h and b) 16 h following upper gastrointestinal series (barium swallow). a) The lungs are clear of focal consolidation and there is a large amount of contrast within the stomach and proximal small bowel (arrows). b) There is new dense consolidation of the visualised right lung (arrows).

Figure 2.

A contrast chest computed tomography scan from a 67-year-old male with respiratory failure 1 day after upper gastrointestinal series (barium swallow). There are hyperdensities within the right lower lobe bronchi (arrows) representing aspirated barium with surrounding consolidation.