Accidental concentrated hydrogen peroxide ingestion associated with portal and systemic venous gas

2017-08-24 18:49:21

Category: Abdominal Imaging, Region: Abdomen-Liver, Plane: Axial

Accidental ingestion of high concentration hydrogen peroxide has been shown to cause extensive injury to surrounding tissues. The injury occurs via three main mechanisms: corrosive damage, oxygen gas formation, and lipid peroxidation. In this study, we report a case of a 52-year old male patient who accidentally ingested a high concentration (35%) of hydrogen peroxide thinking it was water after a family member mistakenly placed a water jar filled with hydrogen peroxide in the fridge. Following ingestion, patient had nausea and vomited 6 to 7 times, then drank 2 glasses of milk to try and relieve the intense central burning sensation and then went to the emergency department. CT abdomen was performed, revealing extensive portal vein gas. Patient was treated with hyperbaric oxygen therapy and symptoms resolved. MRI brain was normal; no intravascular cerebral air or infarct. However, upper endoscopy showed caustic distal esophageal injury and hemorrhagic gastritis. Few days later, patient recovered fully from the incident and was discharged. Axial CT image of the abdomen with IV contrast demonstrating extensive portal venous gas throughout the liver (red arrows) and in the extra-hepatic portal vein (curved arrow). Pneumatosis in the wall of the gastric antrum (white arrow).