Digestive and Liver Disease 48 (2016) 824
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An unusual and unexpected finding in a case of self-poisoning Marie-Liesse Jeanjean a , Brigitte Couturier b , Céline Gregoire c , Arnaud Galbois a,d,∗ a
Générale de Santé, Hôpital Privé Claude Galien, Service de Réanimation Polyvalente, 91480 Quincy-sous-Sénart, France Générale de Santé, Hôpital Privé Claude Galien, Service de Chirurgie Viscérale, 91480 Quincy-sous-Sénart, France c Générale de Santé, Hôpital Privé Claude Galien, Service d’Accueil des Urgences, 91480 Quincy-sous-Sénart, France d AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012 Paris, France b
Fig. 2.
Fig. 1.
A 65 year old man with history of severe depression was admitted for impaired consciousness after having ingested 30 tablets of cyamemazine and venlafaxine. The extra-neurological physical examination and the chest X-ray were normal. The day after, the chest X-ray revealed metal foreign bodies in the colon’s left angle and the patient declared having ingested sharp pointed metal tools during the past three days. Abdominal X-ray (Fig. 1) and CT-scan revealed the presence of dozens of metal foreign bodies along the
digestive tract, including an extra-digestive needle with an inflammation of the surrounding fat. Laparoscopy allowed to drain the abscess opposite an 8 cm needle piercing the duodenal wall, and to extract numerous sharp-pointed tools stuck in the stomach (Fig. 2). Abdominal X-ray could have allowed an earlier diagnosis but it is not systematically recommended in patients with self-poisoning. According to guidelines, CT-scan can be performed before surgery [1]. Emergent endoscopy is mandatory for esophageal obstruction, batteries or sharp-pointed objects in the esophagus; urgent endoscopy is required for sharp-pointed objects in the stomach or duodenum and objects > 6 cm [1]. Surgery is required for unmoving sharp-pointed objects within 3 days and peritonitis [1]. Laxatives are contraindicated. Daily abdominal X-ray was performed to ensure the natural extraction of the remaining objects. No abdominal symptom occurred and the patient was referred to a psychiatry department 16 days after. Reference
∗ Corresponding author at: Générale de Santé, Hôpital Privé Claude Galien, Service de Réanimation Polyvalente, 91480 Quincy-sous-Sénart, France. Tel.: +33 1 69 39 90 94. E-mail address:
[email protected] (A. Galbois).
[1] ASGE Standards of Practice CommitteeIkenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointestinal Endoscopy 2011;73:1085–91.
http://dx.doi.org/10.1016/j.dld.2016.03.021 1590-8658/© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
