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CASE SNIPPET
Year : 2013  |  Volume : 59  |  Issue : 1  |  Page : 63-64

Use of percutaneous endoscopic gastrostomy tube as a conduit for endoscopic retrieval of accidentally ingested mercury


1 Department of Surgery, Visiting Surgical Gastroenterologist and Laparoscopic Surgeon, Fortis Hiranandani Hospital, Mini Seashore Road, Sector 10, Vashi, Navi Mumbai, Maharashtra, India
2 Department of Surgery, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication22-Mar-2013

Correspondence Address:
G Dahiya
Department of Surgery, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.109502

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How to cite this article:
Gandhi J A, Dahiya G. Use of percutaneous endoscopic gastrostomy tube as a conduit for endoscopic retrieval of accidentally ingested mercury. J Postgrad Med 2013;59:63-4

How to cite this URL:
Gandhi J A, Dahiya G. Use of percutaneous endoscopic gastrostomy tube as a conduit for endoscopic retrieval of accidentally ingested mercury. J Postgrad Med [serial online] 2013 [cited 2020 Jul 7];59:63-4. Available from: http://www.jpgmonline.com/text.asp?2013/59/1/63/109502


A 42-year-old male presented to the emergency surgery room (ESR) with complaint of accidental mercury ingestion. As recorded by a glass mercury thermometer, the patient was febrile for 3 days before admission. He had a history of stroke 6 months prior, the sequelae of which, a sudden spastic attack, resulted in accidental chewing of the thermometer. The patient also had an indwelling percutaneous endoscopic gastrostomy (PEG) for severe dysphagia post the episode of stroke.

On examination, the patient was conscious and alert. He was given a gentle head-low position, and X-ray of the chest and abdomen was done to confirm the diagnosis. In view of the diagnosis, the patient was taken up for an emergency upper gastrointestinal (GI) tract endoscopy to retrieve the mercury and prevent its systemic absorption and toxicity. The procedure was done under total intravenous anesthesia (TIVA).

The mercury in the patient's stomach was aggregated in the fundus using the flush technique. An attempt to use the 1-mm suction channel of a flexible endoscope was futile due to the high surface tension of mercury. [1] The operating surgeon therefore used the existing PEG tube to retrieve the mercury. The tube was moved in a retrograde manner to reach the mercury that had been re-collected in the fundus [Figure 1]. Suction was applied to the PEG tube after establishing contact between the mercury and the funnel end of the tube [Figure 2]. Three sittings ensured complete clearance of the mercury. This was confirmed post-operatively by an X-ray of the abdomen.
Figure 1: Retrograde passage of percutaneous endoscopic gastrostomy tube

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Figure 2: Mercury within percutaneous endoscopic gastrostomy tube

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Mercury removal from the GI is an extremely challenging task, requiring emergency expertise. The heavy metal with its large number of side effects, [2],[3] when exposed to, may be lethal. Despite the ban on mercury-containing instruments by the Ministry of Health and Family Welfare over 2 years ago, [4] mercury glass thermometers are still very much in use in most government hospitals. Usage of mercury thermometers on a day-to-day basis especially among certain groups of patients, such as children, psychiatric patients, and those with a history of cerebrovascular accidents, can result in dangerous situations such as the one mentioned above. To prevent any such mishaps and to reduce the environmental hazards of mercury, we advise replacement of existing glass thermometers with digital ones.

Accidental mercury ingestion is a rare presentation, with no set protocol for its management. On the basis of our case, we recommend immediate head-low position before any intervention can be undertaken. Funneled or wide-bore tubes must be used for suction of the heavy metal to break its high surface tension.

 
 :: References Top

1.Vowell S. Microfluidics: The Effects of Surface Tension.[Internet]. University of Washington. Department of Physics: Washington. Available from: http://www.phys.washington.edu/~sharpe/486/vowell_f.pdf. [Last cited on 2009 Mar 19].  Back to cited text no. 1
    
2.Sarikaya S, Karcioglu O, Ay D, Cetin A, Aktas C, Serinken M. Acute mercury poisoning: A case report. BMC Emerg Med 2010;10:7.  Back to cited text no. 2
[PUBMED]    
3.Tchounwou PB, Ayensu WK, Ninashvili N, Sutton D. Environmental exposure to mercury and its toxicopathologic implications for public health. Environ Toxicol 2003;18:149-75.  Back to cited text no. 3
[PUBMED]    
4.Ministry of Health and Family Welfare. Directorate General of Health Services. Available from: http://www.mercuryfreehealthcare.org/guidelines.pdf [Last cited on 2010 Mar 08].  Back to cited text no. 4
    


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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