Hemodialysis patients are a group of critically ill patient with multiple co-morbidities as the risk factors of developing vascular access complications and death. Creation of fistula before initiation of hemodialysis will reduce the IJC related complications. Vascular access complications will contribute to the increased mortality and socioeconomic burden.

In this study, the frequency of infection and thrombosis were not significantly increased in the buttonhole group but it might be due to small sample size, high dropout rate and short duration of the study. The practice of buttonhole cannulation should be encouraged provided cost is not a factor.

Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature.
Barium Sulfate/administration & dosage ; Barium Sulfate/*adverse effects ; Colon ; Colostomy ; Enema/*adverse effects ; *Iatrogenic Disease ; Peritonitis/*chemically induced