Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Abstract

Anna Lepore,1 Davide D’Antini,1 Pasquale Raimondo,2 Lucia Mirabella,1 Leonardo Pennisi,1 Giuseppe Carrillo,1 Antonella Cotoia,1 Michele Dambrosio,1 Gilda Cinnella1 1Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia, 2Department of Anesthesia and Intensive Care, “Santa Maria” Hospital, Via De Ferrariis, Bari, Italy Abstract: Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy. Keywords: abdomen, acute, caustics, sulfuric acid, suicide, attempted, peritonitis, laparotomy 

Keywords

• caustic
• injury
• household cleaning products
• poisoning
• damage control
• open abdomen