Surgical decontamination in ferrous sulfate intoxication

Article information

Acute Crit Care. 2019;34(3):232-234

Publication date (electronic) : 2019 April 24

doi : https://doi.org/10.4266/acc.2018.00409

Jung-In Ko¹, Kyung Su Kim^,2, Gil Joon Suh^2,3, Seong-Ho Kong⁴, Yoon Sun Jung²

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 2018 December 24; Revised 2019 April 12; Accepted 2019 April 12.

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.

Figure 1.

Abdominal plain radiograph. Most tablets remained inside the stomach.

Figure 2.

Emergency endoscopic findings. The stomach mucosa was covered with black granules, and many tablets were tangled and stuck to the stomach wall.

Figure 3.

Emergency laparotomy and tablet removal.

Figure 4.

The surgically removed tablets.

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.