Aluminum Phosphide Induced Esophageal Stricture, an Unusual Complication

Abstract

Purpose: Aluminum phosphide is a common popular pesticide used to preserve grain and cereals in India. There are anecdotal reports of acute poisoning in world literature with survival on supportive measures, however the prognosis is dismal despite best intensive care.There is no antidote available for counteracting the deleterious effects of Aluminum phosphide (Celphos).Awareness of its extreme lethal nature among population has brought up this poison on the forefront of mode of suicide. Aluminum phosphide is very effective in preventing infestation with peots and rodents. Thus this pesticide is easily available on the agricultural accessory shop as over the counter drug. The poisoning with Aluminum phosphide usually culminates in mortality. However, few cases have shown survival like, ingestion of old tablet, ingestion along with water and dry gulping of tablet. The various systemic manifestation of acute poisoning includes cardio respiratory failure, peripheral circulatory failure, metabolic acidosis and shock. Gastrointestinal manifestation includes nousea, vomiting, epigastric pain, diarrhea, abdominal cramps, and backache due to hypotension. Methods: We came across 104 cases of celphos poisoning, admitted in our institution during last one year, out of which 60 cases (57.6%) died. Among the remaining 34 cases who survived, 12 (7 male 5 female,15–45 years)cases were presented with dysphasia which was progressive initially to solids & subsequently to liquids after a mean period of 35+_6 days. Results: On endoscopic & barium sollow evaluation all had smooth narrowing with short segment esophageal stricture (6mm-25 mm) except one patient who had tracheoesopheagal fistula. Ten patients were subjected to dilatation with Savary gilliard dilators, with complete relief of dysphasia after 3–4 session of dilatation. Complications like post dilatation bleeding were observed in two cases, resolved spontaneously. Two patients were subjected to surgery, one with tracheoesophageal fistula and other with tight irregular stricture, with successful outcome. Esophageal perforation was not seen in any of the cases. Conclusions: Aluminum phosphide is a common suicidal poisoning in India with very high mortality despite best intensive care. Among the survivors, presentation with stricture esophagus is unusual finding in literature, which can be explained by dry gulping of the tablets leading to local damage to esophagous?