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Image in critical care Surgical decontamination in ferrous sulfate intoxication
Jung-In Ko1orcid, Kyung Su Kim2orcid, Gil Joon Suh2,3orcid, Seong-Ho Kong4orcid, Yoon Sun Jung2orcid
Acute and Critical Care 2019;34(3):232-234.
DOI: https://doi.org/10.4266/acc.2018.00409
Published online: April 24, 2019
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1Department of Emergency Medicine, National Medical Center, Seoul, Korea

2Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea

3Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea

4Department of Surgery, Seoul National University Hospital, Seoul, Korea

Corresponding author Kyung Su Kim Division of Critical Care, Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-4751 Fax: +82-2-741-7855 E-mail: kanesu@gmail.com
• Received: December 24, 2018   • Revised: April 12, 2019   • Accepted: April 12, 2019

Copyright © 2019 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 32-year-old woman was transferred to the emergency room after ingestion of 200 tablets of 80 mg ferrous sulfate for suicide. She received gastric lavage 30 minutes after ingestion and activated charcoal before transfer. Most tablets remained inside the stomach on abdominal plain radiography (Figure 1). The initial serum iron level was 326 μg/dl (normal range, 50 to 130 μg/dl), and deferoxamine therapy was started with 15 mg/kg/hr for 24 hours. Emergency endoscopy was performed 15 hours after ingestion. Not all tablets could be removed because of increased bleeding tendency due to black granules covering the gastric mucosa and numerous tangled tablets (Figure 2). At 23 hours after ingestion, she underwent emergency laparotomy, and a total of 114 tablets was removed (Figures 3 and 4). Serum iron level was normalized at the day after surgery.
In this case, without mechanical removal, the ingested tablets would have remained in the stomach for a long time. Instead, the patient recovered after emergency laparotomy. In conclusion, surgical removal may be an option if endoscopic decontamination is impossible for early decontamination in acute iron intoxication.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

Conceptualization: KSK, GJS. Data curation: JIK, SHK. Writing - original draft: JIK, KSK. Writing - review & editing: GJS, SHK, YSJ.

This case report was approved by the Institutional Review Board of study hospital (IRB No. 1712-162-913) and written informed consent was waived.
Figure 1.
Abdominal plain radiograph. Most tablets remained inside the stomach.
acc-2018-00409f1.jpg
Figure 2.
Emergency endoscopic findings. The stomach mucosa was covered with black granules, and many tablets were tangled and stuck to the stomach wall.
acc-2018-00409f2.jpg
Figure 3.
Emergency laparotomy and tablet removal.
acc-2018-00409f3.jpg
Figure 4.
The surgically removed tablets.
acc-2018-00409f4.jpg

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