This is a report about five patients who suffered a perforation of the colon during a barium-sulfate enema. In one case, barium leaked into the intraperitoneal cavity causing a barium peritonitis. In the other four cases, leakage into the retroperitoneal cavity occurred. All patients underwent surgical removal and drainage of the barium-sulfate and subsequently required a colostomy. In two cases a bowel resection was additionally performed. In one case the defect re-sutured. Antibiotic therapy was included in all cases. All patients survived the incident and were discharged between 20 days and four months postoperatively. Publications and personal experience led us to manage intraperitoneal or large retroperitoneal perforations by prompt laparotomy with removal of barium and faeces. A proximal colostomy is also required. In smaller retroperitoneal perforations conservative management is feasible, however, if the patient's condition deteriorates, they should be treated as recommended for an intraperitoneal perforation.