Friesenbichler Joerg, Maurer-Ertl Werner, Sadoghi Patrick, Wolf Elisabeth, Leithner Andreas
Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria.
BMC Surg. 2011 Nov 17;11:31. doi: 10.1186/1471-2482-11-31.
Accidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions.
Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally.
Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.
意外或故意皮下和/或肌肉注射金属汞是一种不常见的中毒形式。虽然它不像吸入汞蒸气那样具有相同的风险，但可能会引起早期和晚期的破坏性反应。
在此，我们报告一例29岁男性患者，在初次就诊前约15年，出现强迫性障碍，导致其向左膝周围软组织注射元素汞及其他几种异物的自伤行为。为进行临床检查，对患区进行了X线检查和CT扫描。此外，采集血液以测定血液中的汞浓度，结果显示该浓度比推荐值高17倍。因此，对汞沉积部位和几个异物进行了边缘切除。
手术后血液中的汞水平将迅速下降，尤其是在联合螯合疗法的情况下。对于皮下和肌肉注射金属汞的情况，我们建议对所有受污染组织进行边缘或广泛切除，以防止汞迁移和慢性炎症。然而，应进行数年的长期临床和生化监测，以筛查慢性中毒情况。
