Dear Editor, Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete colonoscopy,1 with an additional diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the non-visualised portion of the colon.2 However, severe complications of colorectal perforation can occur rarely in 0.02% to 0.04% of patients.3 High morbidity and mortality of 50% in patients with colorectal perforation during barium examination have been reported.4 This complication is a relatively common cause of medical malpractice litigation involving radiologists. At present, colonoscopy is the investigation of choice in diagnosing colorectal cancer. Once the diagnosis has been made, contrast-enhanced computed tomography (CT) scan of the abdomen is commonly used for staging purposes. In this article, we retrospectively reviewed 2 patients who developed barium peritonitis followed by DCBE. This complication could have been prevented had the signs of colonic perforation been picked up from the CT scan performed after the colonoscopy.