Volume 71 - 2008 - Fasc.3 - Letters
Early endoscopic gastric lavage for acute iron overdose : a novel approach to accidental pill ingestions
Iron pills are typically prescribed for pregnant females or children. Very few reports exist regarding acute iron ingestion in adults. Management of acute iron ingestion in adults is not well described. A twenty one year old, healthy man presented to the emergency room one hour after ingestion of approximately thirty 325 mg ferrous sulfate tablets with suicidal intent. After initial assess- ment, abdominal plain film showed a conglomerate of iron tablets in the gastric fundus. Laboratory tests were significant for an elevated serum iron level of 246 µg/dL (49-181 µg/dL), and an iron saturation of 82% (13-59%). Extensive gastric lavage was performed in the emer- gency room with the aim to evacuate the tablets. However, repeat abdominal plain film showed persistent presence of iron tablets in gastric fundus. Repeat serum iron level was 271 µg/dL. Severe corrosive risks of iron intoxication to the gastrointestinal mucosa, as well as the potential fatal risks of systemic iron overdose prompted us to proceed with endoscopy directed gastric lavage. Under conscious sedation, upper gastrointestinal endoscopy was performed. The evaluation of the stom- ach showed diffuse hemorrhagic gastritis with friable mucosa. There was a large amalgam of iron pills in the gastric fundus. After the placement of an over-tube a Roth-Net basket was used to retrieve some of the iron pills. A biopsy forceps was used to breakdown the remaining pills, followed by generous irrigation and suc- tion. Repeat abdominal films showed complete evacua- tion of iron from the stomach and absence of passage of any tablets into the small bowel. Repeat iron levels nor- malized at 129 µg/dL.
Metastatic pancreatic cancer presenting as a bleeding duodenal ulcer 30 months after initial diagnosis of duodenal ulcer. Should duodenal ulcers be biopsied or followed up with repeat endoscopy ?
Management of duodenal ulcer (DU) includes correc- tion of underlying cause and a course of proton pump inhibitors for ulcer healing. In patients with Helicobacter pylori related DU, H pylori should be eradicated. In patients with non-steroidal anti-inflammatory drugs (NSAIDS), NSAIDS should be stopped or switched to a COX-2 inhibitor if possible (1). Unlike gastric ulcer, most management guidelines do not recommend routine biopsy of the ulcer edge to exclude, nor follow-up endoscopy to document healing (1-2). We report a patient who presented with a duodenal bulb ulcer associated with H. pylori, who was treated but defaulted follow-up and subsequently presented with an ulcer at the same location, which turned out to be malignant.
A 46 years old male smoker was referred to our department for 2 days of epigastric pain.
