Michielan Andrea, Schicchi Azzurra, Cappuccio Roberto, Lonati Davide, Lamboglia Francesca, Vitalba Alessandra, Caroli Alessandro, Crevani Marta, Locatelli Carlo A, Betetto Giorgio
a Department of Surgery, Gastroenterology and Digestive Endoscopy Unit , Presidio Ospedaliero Santa Chiara , Trento , Italy.
b Poison Control Centre and National Toxicology Information Centre - Toxicology Unit , Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital and University of Pavia , Pavia , Italy.
Clin Toxicol (Phila). 2018 Jan;56(1):69-73. doi: 10.1080/15563650.2017.1338346. Epub 2017 Jun 26.
Ingestion of elemental mercury (Hg0) is considered non-toxic. After massive ingestion, local intestinal complications may develop: retention within appendix is quite frequent but treatment is debated. We describe a case of intentional ingestion of Hg0 requiring multi-step decontamination and prophylactic appendectomy. Case detail: A 19-year-old woman was admitted to ED for abdominal pain. History revealed ingestion of large amount of Hg0 as suicide attempt. To prevent absorption, facilitate elimination, and avoid complications a conservative approach was started. Due to inefficacy of initial maneuvers colonoscopy with irrigation/aspiration was performed, repeated whole bowel irrigation was continued and second colonoscopy was performed to clean residual metal. Abdominal plain films confirmed the presence of retained mercury within the appendix in asymptomatic patient. To reduce risk of appendicitis, potential perforation, and possibly systemic toxicity, a prophylactic laparoscopic appendectomy was performed at day 5 with removal of all retained mercury without peritoneal spillage. Highest mercury concentration was 22.7 mcg/L in serum (1-4.5 mcg/L) and 5.1 mcg/L in urine (0.1-5 mcg/L).
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.
摄入元素汞（Hg0）被认为是无毒的。大量摄入后，可能会出现局部肠道并发症：阑尾内潴留较为常见，但治疗方法存在争议。我们描述了一例因故意摄入Hg0而需要多步骤去污和预防性阑尾切除术的病例。病例详情：一名19岁女性因腹痛入住急诊科。病史显示其为自杀企图而摄入了大量Hg0。为防止吸收、促进排出并避免并发症，开始采取保守治疗方法。由于初始措施无效，遂进行了结肠镜灌洗/抽吸，持续进行重复全肠道灌洗，并再次进行结肠镜检查以清除残留金属。腹部平片证实无症状患者的阑尾内存在潴留汞。为降低阑尾炎、潜在穿孔以及可能的全身毒性风险，在第5天进行了预防性腹腔镜阑尾切除术，清除了所有潴留汞且未发生腹腔污染。血清中汞的最高浓度为22.7微克/升（正常范围1 - 4.5微克/升），尿液中为5.1微克/升（正常范围0.1 - 5微克/升）。
摄入后，阑尾内金属潴留较为常见。关于最佳治疗的证据各不相同且基于病例报告。建议采取针对患者的多学科评估多步骤方法。
