Intentional ingestion of elemental mercury requiring multi-step decontamination and prophylactic appendectomy: a case report and treatment proposal

Michielan, Andrea; Schicchi, Azzurra; Cappuccio, R.; Lonati, Davide; Lamboglia, Francesca; Vitalba, Alessandra; Caroli, A.; Crevani, Marta; Locatelli, Carlo; Betetto, Giorgio

doi:10.1080/15563650.2017.1338346

Cited by 6 publications

(16 citation statements)

References 16 publications

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“…In a recently published paper by Michielan et al[3], a review of similar case reports was performed. Including their own case, they found only 10 described cases of elemental mercury sequestration in the appendix after oral ingestion.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical consequences of oral ingestion of mercury are largely unknown since the vast ma-jority of systemic toxicity is associated with the inhalation route[4]. Acute ingestion of elemental mercury is even considered non-toxic due to negligible absorption by intact GI mucosa (oral bioavailability of 0.04%)[3] Furthermore, most foreign bodies that enter the GI tract are eliminated in four to six days[5]. However, due to the vertical anatomy at the coecal region, foreign bodies heavier than other bowel contents are capable of entering the lumen of the appendix (elemental mercury for instance) where the peristalsis is insufficient to push it back into the GI tract[4-6].…”

Section: Discussionmentioning

confidence: 99%

“…Its human toxicity is well-established and varies with the form of mercury, the dose and the type of exposure[1]. Acute ingestion of elemental mercury is considered non-toxic due to the negligible absorption by intact gastrointestinal (GI) mucosa (oral bioavailability of 0.04%)[3]. However, after ingestion of even small amounts of elemental mercury, sequestration in the appendix is possible and subsequent local complications can occur[3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Acute ingestion of elemental mercury is considered non-toxic due to the negligible absorption by intact gastrointestinal (GI) mucosa (oral bioavailability of 0.04%)[3]. However, after ingestion of even small amounts of elemental mercury, sequestration in the appendix is possible and subsequent local complications can occur[3,4]. Due to limited data in the literature the optimal management of patients is still not clear.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report

Norčič¹,

Čebron²,

Sever³

et al. 2019

WJCC

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BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion, retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix, managed by laparoscopic appendectomy. CASE SUMMARY A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal (GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures. Consequently, following deliberations by an interdisciplinary team of specialists, laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful. CONCLUSION Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report

Norčič¹,

Čebron²,

Sever³

et al. 2019

WJCC

View full text Add to dashboard Cite

show abstract

“… 3 Prophylactic appendectomy vs. conservative management has been described for retained mercury in the appendix. 4 , 5 …”

Section: Discussionmentioning

confidence: 99%

Mercury Ingestion

Amin

Huang

Challa

et al. 2018

Clinical Practice and Cases in Emergency Medicine

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Mercury

2023

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Mercury is a global pollutant that exists in three oxidation states: Hg 0 (metallic), Hg + (mercurous), and Hg 2+ (mercuric) mercury. In organometallic derivatives, such as methylmercury (CH 3 Hg + ), mercury is covalently bound to carbon. In its elemental form, mercury is a dense, silvery‐white, shiny metal, which is liquid at room temperature and boils at 357°C. At 20°C, the vapor pressure of the metal is 0.17 Pa (0.0013 mmHg), and a saturated atmosphere at this temperature contains a mercury concentration of 14 mg Hg/m 3 , which is more than 200 times the occupational exposure limit. Hg 0 residence in the atmosphere can be high (greater than a year). Mercury compounds differ greatly in their solubility, with metallic mercury being very sparingly soluble, and several salts, such as mercuric chloride, being soluble in water. Of relevance for its environmental fate, methylmercury interacts with nucleophilic groups (i.e. thiols) in aquatic organisms (mainly fish), being bioaccumulated and biomagnified in the aquatic food chain, which represents a major source of human exposure. Both Hg 2+ and methylmercury have strong affinity for thiol groups, in such a way that in the presence of living cells and dissolved organic matter, they will be found mainly bound to sulfide‐ or thiol‐containing molecules.

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Intentional ingestion of elemental mercury requiring multi-step decontamination and prophylactic appendectomy: a case report and treatment proposal

Abstract: After ingestion, metal retention in appendix is quite frequent. Evidence about optimal treatment are different and based on case reports. A multi-step approach with multidisciplinary evaluation tailored to the patient is suggested.

Cited by 6 publications

References 16 publications

Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report

Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report

Mercury Ingestion

Mercury

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