Charcoal Peritonitis Causing Chronic Pelvic Pain: A Unique Complication Following Bariatric Surgery

Abstract

Routine pathologic examination of a specimen transformed a common diagnosis of endometriosis into a search for an unusual cause of recurrent pelvic pain. Laparoscopy was suspicious for endometriosis, but instead on microscopic examination a black pigment of unknown origin was present. In a subsequent interview with her gynecologist the 38-year-old patient divulged a previous Roux-en-Y gastric bypass (RYGBP), followed 8 weeks later by a suicide attempt by overdosing on medication, treated with charcoal gastric lavage. Her tiny gastric pouch was perforated and she developed charcoal peritonitis. If the emergency room physicians had been aware of her recent RYGBP, they may not have performed the lavage, and if the gynecologist had been aware of the history, she may not have been incorrectly diagnosed endometriosis.

A Review of the Toxicologic Implications of Obesity

“…In addition to a lack of data to support its use, there is reason to believe that the reduced gastric volume in addition to the presence of anastomotic sites would lead to an increased risk of perforation. One such case involved a woman who underwent gastric lavage and charcoal decontamination 8 weeks following Roux-en-Y gastric bypass [126]. This led to disruption of the post-operative gastric pouch, spilling of charcoal into the peritoneum, and peritonitis requiring laparotomy and wash-out.…”

Black Macular Patches on Parietal Peritoneum and Other Extraintestinal Sites from Intraperitoneal Spillage and Spread of India Ink from Preoperative Endoscopic Tattooing: An Endoscopic, Surgical, Gross Pathologic, and Microscopic Study

“…We confirm and extend these cases by reporting three further cases in which endometriosis was absent from the patient history, to further characterize this clinical, surgical, and pathologic phenomenon. In all three current cases other evident causes of black tissue deposits were excluded: melanosis from anthraquinone-containing laxatives [8]; melanin from metastatic melanoma [9]; iron deposits from iron ingestion [10]; charcoal from charcoal ingestion [11]; and tissue necrosis [12].…”