Early Intestinal Obstruction in Iron Toxicity – An Unheard of Occurrence

Abstract

Deliberate self-harm by overdosing on iron tablets although rare is an emergency and requires early recognition and intervention. We present the case of a 19-year-old girl who presented with abdominal distension, colicky abdominal pain, obstipation and intractable vomiting two days after an attempt at deliberate self-harm with ingestion of 30 iron tablets. She was admitted at another hospital, underwent gastric lavage and was monitored in their intensive care unit (ICU) for two days following which she was asymptomatic at discharge. At our hospital, abdominal radiographs showed multiple air fluid levels and dilated bowel loops. CECT showed focal thickening of the distal ileum with luminal occlusion, mesenteric hyperemia and fat stranding. She made complete recovery after conservative management with bowel rest, Deferoxamine (DFO) therapy and supportive care. Segmental enteritis caused by iron ingestion has not been well described and its sequelae causing luminal occlusion leading to intestinal obstruction within a week is very rare. Due to the infrequent occurrence of this condition and lack of evidence, management of intestinal obstruction following iron toxicity is case based. However, rigorous monitoring and follow up until complete resolution of symptoms is essential.

Keywords

• deliberate self-harm
• ferrous sulphate
• segmental enteritis