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: Identificar factores asociados a la ruptura de aneurismas cerebrales en pacientes del Hospital Nacional Edgardo Rebagliati Martins (HNERM) en el año 2009. Métodos: Estudio analítico de corte transversal. Se analizaron 69 historias clínicas de hospitalización, 51 tuvieron diagnóstico de hemorragia subaracnoidea (HSA) aneurismática y 18 de aneurisma cerebral sin ruptura. La edad, sexo, hipertensión arterial, obesidad, diabetes mellitus tipo 2, hipercolesterolemia, consumo de alcohol, tabaco y café; localización y tamaño del aneurisma fueron evaluados como factores asociados mediante las pruebas de Chi-Cuadrado, t de Student; Odds Ratio (OR). Resultados: La localización más frecuente de los aneurismas fue en la arteria comunicante posterior (37.3%). Se encontraron seis casos de aneurismas múltiples, de estos, un 66.6% culminaron en HSA. Se encontró diferencias significativas entre el sexo femenino (p=0.007, OR=0.09; IC95%: 0.01-0.74), la localización del aneurisma intracraneal (p=0.031, p<0.05) relacionados con el suceso de ruptura de aneurismas cerebrales. Conclusiones: En los pacientes del HNERM, durante el año 2009, la ubicación del aneurisma cerebral y el sexo femenino han sido factores asociados al desarrollo de HSA aneurismática. Los resultados no significativos obtenidos en los demás factores postulados pueden explicarse por una insuficiente recolección de datos en la historia clínica.
Objective: To identify factors associated with the rupture of cerebral aneurysms in patients at Hospital Nacional Edgardo Rebagliati Martins (HNERM) in 2009. Methods: Cross-sectional analytical study. We analyzed medical records of 69 hospitalized, 51 were diagnosed with aneurysmal SAH and 18 unruptured cerebral aneurysm. Age, sex, hypertension, obesity, type 2 diabetes mellitus, hypercholesterolemia, alcohol, snuff and coffee, location and size of the aneurysm were evaluated as factors associated with the Chi-square, Student t, Odds Ratio (OR). Results: The most common location of aneurysms was the posterior communicating artery (37.3%). We found six cases of multiple aneurysms of these, 66.6% resulted in SAH. Significant differences were found between female gender (p=0.007, OR=0.09, CI95% 0.01 to 0.74), the location of intracranial aneurysm (p=0.031, p<0.05) related to the event of rupture of cerebral aneurysms. Conclusions: In patients from the HNERM, in 2009, the location of cerebral aneurysms and female sex were factors associated with development of aneurysmatic SAH. The non significant results obtained in other factors postulates can be explained by insufficient data collection on medical history.
