ABSTRACT
Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.
ABSTRACT
Objetivo: Realizar la recopilación de la información más relevante descrita en diversos artículos científicos acerca del vólvulo de sigmoides, e integrarla para la puesta al día del cirujano. Materiales y métodos: Se realiza una estrategia de búsqueda para el desarrollo de la revisión, haciendo uso de PubMed y Cochrane Library. Resultados: La etiología del vólvulo de sigmoides es multifactorial, siendo el sigmoide redundante un factor predisponente. La incidencia más alta se da entre los 40 a 80 años. Es más común en hombres. En casi el 100 % de pacientes, el dolor abdominal es el síntoma principal, asociado a distención abdominal y dificultad para eliminar flatos. La radiografía simple de abdomen es diagnóstica en el 57% - 90% de pacientes. La detorsión endoscópica flexible es la principal opción de tratamiento, con tasas de éxito del 33% al 91%. La cirugía de emergencia se reserva para los casos complicados. Conclusiones: El vólvulo de sigmoides, es la rotación del sigmoide alrededor de sí mismo y su mesenterio. Los síntomas principales son dolor abdominal, distensión y dificultad para eliminar flatos. Los exámenes auxiliares incluyen la radiografía simple de abdomen, la tomografía y la resonancia. La endoscopia muestra un giro espiral de la mucosa en forma de esfínter. Se debe realizar unidad clínica, radiológica, endoscópica y, a veces, quirúrgica, para su diagnóstico. La devolvulación endoscópica se sugiere como principal opción terapeutica. La cirugía de emergencia se reserva para casos complicados. Esta patología aun presenta una elevada morbimortalidad. (AU)
Objective: To compile the most relevant information described in various scientific articles about the sigmoid volvulus, and integrate it for the surgeon's update. Materials and methods: A search strategy was developed for the development of the review, using PubMed and the Cochrane Library. Results: The etiology of the sigmoid volvulus is multifactorial, being the redundant sigmoid a predisposing factor. The highest incidence occurs between 40 to 80 years. It is more common in men. In almost 100% of patients, abdominal pain is the main symptom, associated with abdominal distension and difficulty in eliminating flatus. Plain radiography of the abdomen is diagnostic in 57% - 90% of patients. Flexible endoscopic detortion is the main treatment option, with success rates of 33% to 91%. Emergency surgery is reserved for complicated cases. Conclusions: The sigmoid volvulus is the rotation of the sigmoid around itself and its mesentery. The main symptoms are abdominal pain, distension and difficulty to eliminate flatus. Auxiliary exams include plain abdominal radiography, tomography and MRI. The endoscopy shows a spiral twist of the mucosa in the form of a sphincter. A clinical, radiological, endoscopic and, sometimes, surgical unit must be performed for its diagnosis. Endoscopic devolvulation is suggested as the main therapeutic option. Emergency surgery is reserved for complicated cases. This pathology still presents a high morbidity and mortality. (AU)
