When surgery isn't the culprit: A case report of barium poisoning mistaken for a post-operative complication

Abstract

Barium poisoning can progress from gastrointestinal hypermotility (vomiting, abdominal cramps, and diarrhea) to flaccid paralysis, areflexia, respiratory failure, and cardiovascular dysfunction. This report aims to present a case of a 25-year-old woman with severe obesity, who underwent a sleeve gastrectomy complicated by a suture line leak and subsequent gastric stenosis. Following the resolution of the stenosis, the patient experienced recurrent gastrointestinal symptoms without an apparent cause, accompanied by hypokalemia. Over time, she developed generalized muscle weakness. The patient presented to the ED with altered mental status, nystagmus, generalized muscular weakness, and hypokalemia (2.7 mmol/L). A thorough etiological investigation of neurological symptoms was initiated. Testing revealed elevated urinary barium levels (43.9 µg/L) 12 days after admission, suggesting that higher levels would have been identifiable at admission and may have contributed to vomiting and muscular weakness.