Endoscopic management of massive mercury ingestion

Zag, Levente; Berkes, Gábor; Takács, Irma F.; Szepes, Attila; Szabó, István

doi:10.1097/md.0000000000006937

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…For example, the lumen can become inflamed and perforated, resulting in the possible effusion of mercury into the peritoneal cavity, thereby causing subsequent systemic toxicity and peritonitis [18]. On the other hand, a conservative approach that includes gastric lavage, cleaning up via motility, and use of decompression colonoscopy helps with the elimination [20,[23][24]. Additionally, the left lateral decubitus positioning has been successfully employed and offers a potential alternative [25].…”

Section: Discussionmentioning

confidence: 99%

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Roca¹,

Ramos-Yataco²,

Alcalde-Loyola³

et al. 2022

Cureus

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Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

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Section: Discussionmentioning

confidence: 99%

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Roca¹,

Ramos-Yataco²,

Alcalde-Loyola³

et al. 2022

Cureus

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“…The initial problem may lay in the endoscopic investigation as the oesophageal and gastric lesions may be classified as not severe but can eventually deteriorate in a manner that can be lifethreatening and demanding an aggressive surgical intervention. Some articles suggest gastric lavage to be carried out immediately risking the high risk of aspiration [7].…”

Section: Discussionmentioning

confidence: 99%

“…She was kept in the intensive care unit for another endoscopy 12 hours later. The maximum concentration of mercury on the second day upon admission was measured as high as 4940,6ug/L [7,8].…”

Section: Case Presentationmentioning

confidence: 95%

Mercuric chloride poisoning: Oesophagectomy as treatment?

Awad¹,

Guy²,

Monneuse³

2020

Case Rep Imag Surg

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Background: Mercury is one of the most dangerous heavy metals if repeatedly ingested. It existed for medicinal purposes such as thermometers, for disinfection in Arabic medicine and in the consumption of fish in Japan. It exists in several forms and the medical care required for these various forms depends on the mode of intake, the dose and more specifically the pharmacokinetics of each compound. Ingestion of Mercuric chloride is a very rare and medically challenging dilemma as it requires an early multi-departmental approach to the management of the patient.Clinical Presentation: A 32-year-old patient ingested 2g of mercuric chloride for suicidal reasons. Initially presenting to the emergency department with nausea and vomiting admitting she had ingested this compound arose our vigilance with immediate introduction of the chelating agent Dimercaprol and she underwent a series of endoscopies as well as computed tomography (CT) scans before her case deteriorated and she was taken to the operating theatre on day 23 for a total esophagogastrectomy, oesophagostomy and jejunostomy for enteral alimentation.Understanding the sequence of events and the dose of ingested mercuric chloride leads us to a certain degree of assurance that a surgical intervention was required earlier in the course of treatment. The early administration of the chelating agent which has great affinity for mercury compounds helps excrete the mercury safely, the oropharyngeal examination in the initial phase is of great importance as with its corrosive function it may cause an inflammatory stenosis response and/or an eventual intubation. Topographies and endoscopies are also critical in deciding the subsequent steps. Due to the fact that patients develop acute renal failure dialysis becomes a priority as well. Conclusion:What is of importance to us is the multidisciplinary approach to these specific and rare group of patients. The medical care should be meticulously organised in a systematic manner in order for the right decision to be carried out at the right time. In this case of mercuric chloride poisoning an earlier oesophagectomy would have definitely avoided the ongoing necrotic process and would have provided the patient with an earlier reconstructive surgery.

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“…Any case of deliberate injection or ingestion of elemental/inorganic mercury should be discussed with the NPIS to ensure consideration of individual circumstances of exposure and the potential role for decontamination measures including whole bowel irrigation, aspiration or surgical excision 79 86 88 89…”

Section: Mercurymentioning

confidence: 99%

Investigation and monitoring of heavy metal poisoning

Barlow

Bradberry

2022

J Clin Pathol

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Historically, heavy metal measurement and interpretation has been a highly specialised area performed only in a handful of centres within the UK. However, recent years have seen a move to more local testing due to the repatriation of referred work into pathology networks and the increased availability of inductively coupled plasma mass spectrometry technology. While management of significant poisoning is still overseen by tertiary care poisoning specialists, management of milder cases may be undertaken locally.Non-specialist clinical scientists and clinicians need to know when heavy metal testing is appropriate, which samples are required (and any specific requirements around collection) and how to interpret and act on the results.This Best Practice article provides guidance on the investigation and monitoring of the toxic elements most frequently encountered in general medical practice; lead, mercury and arsenic. It is intended as a reference guide for the non-specialist and as a comprehensive summary for clinical toxicologists and clinical scientists.

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Endoscopic management of massive mercury ingestion

Cited by 3 publications

References 11 publications

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Mercuric chloride poisoning: Oesophagectomy as treatment?

Investigation and monitoring of heavy metal poisoning

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