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

Norčič, Gregor; Čebron, Žan; Sever, Primoz; Grosek, Jan; Tomažič, Aleš

doi:10.12998/wjcc.v7.i9.1038

Cited by 4 publications

(9 citation statements)

References 13 publications

(23 reference statements)

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“…13 Elemental mercury sequestration in the appendix may cause local complications, such as acute appendicitis or perforation, which is considered the third most common sequela of appendicitis. 3 However, in our literature review, we found few studies describing the active management of elemental mercury retained in the appendix. 1,8…”

Section: Discussionmentioning

confidence: 90%

“…In particular, elemental mercury that remains in the appendix can cause appendicitis and subsequent local complications. 1–3 Inorganic or organic compounds transformed from elemental mercury could result in chronic toxic effects, such as toxic nephropathy or neurotoxicity, that can persist for decades. 4–6 Therefore, residual elemental mercury in the body requires immediate attention, even after active conservative treatments.…”

Section: Introductionmentioning

confidence: 99%

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Strictly-controlled techniques are required in laparoscopic appendectomy for elemental mercury sequestration in the appendix: a case report

et al. 2023

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Elemental mercury impaction in the appendix can cause subsequent local and systemic complications. We present a case of a teenage boy who ingested approximately 10 mL of elemental mercury, resulting in residual mercury sequestration in the appendix after conservative management. We performed laparoscopic appendectomy to remove the residual mercury. The patient made a complete clinical recovery without adverse events related to mercury poisoning over the 6-month follow-up. We highlight the advantages of laparoscopic appendectomy, abdominal computed tomography (CT), negative pressure operating rooms, and surgeon protection to improve surgical success rates. This case report adds to the literature on the management of elemental mercury impaction in the appendix and provides valuable insights for clinical decision-making.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Strictly-controlled techniques are required in laparoscopic appendectomy for elemental mercury sequestration in the appendix: a case report

et al. 2023

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“…We report the first case of elemental mercury ingestion that occurred as a result of using a folk remedy, with subsequent retention of mercury in the appendix causing appendicitis that leads to peritonitis. Approximately 12 similar cases of mercury sequestration in the appendix and only three cases of appendicitis related to elementary mercury are found in the literature [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Any of the foregoing factors can contribute to mercury being arrested in the cecum during transit and gravitating toward the lower portion of the appendix. In this location, peristalsis motion is usually insufficient to expel the mercury thereby causing sequestration [7,20]. As a result, elementary mercury may remain immobile in the appendix, stimulating an inflammatory reaction with the possibility of perforation leading to peritonitis [5].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, small amounts of elemental mercury can remain in the GI tract, causing nausea, vomiting, abdominal pain, bloody diarrhea, and potential necrosis of the GI tract mucosa [5]. In extremely rare cases, mercury may be sequestered in the appendix, which contributes to the pathophysiology cascade for appendicitis and is an extremely rare cause of peritonitis [6][7].…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 4 publications

References 13 publications

Strictly-controlled techniques are required in laparoscopic appendectomy for elemental mercury sequestration in the appendix: a case report

Strictly-controlled techniques are required in laparoscopic appendectomy for elemental mercury sequestration in the appendix: a case report

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

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