Clinical toxicology (Philadelphia, Pa.) · 2008
Conservative management of elemental mercury retained in the appendix.
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Rusyniak Daniel E, Nanagas Kristine A
Аннотация
INTRODUCTION: Few cases of mercury sequestration in the appendix appear in the literature. Based on these, both prophylactic appendectomy and non-surgical management have been recommended. We report a case in which a patient with mercury retained in the appendix was managed conservatively without developing mercurialism or appendicitis.
CASE REPORT: A 43-year-old man ingested approximately one tablespoon of elemental mercury after an argument with his wife. An initial abdominal radiograph showed mercury in the pylorus of the stomach and a follow-up x-ray at 72 hours showed mercury localized to the appendix. The patient was treated as an outpatient and examined several times over a 37-day period. He never developed signs of appendicitis. On a follow-up examination 7 months after the ingestion, he was radiographically free of mercury. Periodically throughout his clinical course, blood mercury levels were obtained. Only one, 6 days after ingestion, showed an elevated mercury level of 68 mcg/L (reference range <10 mcg/L). Despite this, the patient never developed signs or symptoms of mercury poisoning.
CONCLUSION: Patients in whom elemental mercury is retained in the appendix, who are without symptoms and have normal gastric mucosa, may be conservatively managed without surgery.
CASE REPORT: A 43-year-old man ingested approximately one tablespoon of elemental mercury after an argument with his wife. An initial abdominal radiograph showed mercury in the pylorus of the stomach and a follow-up x-ray at 72 hours showed mercury localized to the appendix. The patient was treated as an outpatient and examined several times over a 37-day period. He never developed signs of appendicitis. On a follow-up examination 7 months after the ingestion, he was radiographically free of mercury. Periodically throughout his clinical course, blood mercury levels were obtained. Only one, 6 days after ingestion, showed an elevated mercury level of 68 mcg/L (reference range <10 mcg/L). Despite this, the patient never developed signs or symptoms of mercury poisoning.
CONCLUSION: Patients in whom elemental mercury is retained in the appendix, who are without symptoms and have normal gastric mucosa, may be conservatively managed without surgery.