Extensive Portal Venous Gas After Hydrogen Peroxide Ingestion

Abstract

Hydrogen peroxide is a clear, colorless liquid that is available in various concentrations ranging from 1.5% to more than 35%. We present a case of accidental hydrogen peroxide ingestion associated with extensive venous portal gas that was successfully treated conservatively. A 52 year old male patient with no significant history was transferred to our hospital after he accidentally ingested around 50 ml of 35% hydrogen peroxide solution few hours prior to presentation. Initially, the patient presented to outside facility with nausea, non-bloody vomiting and epigastric abdominal pain. Vitals were stable. Physical examination was significant for erythematous oral mucosa, epigastric tenderness, with no peritoneal signs. Neurologic and cardiopulmonary examinations were normal. Abdominal Computed tomography (CT) scan showed extensive portal venous gas throughout the liver (Image 1). CT and Magnetic resonance imaging (MRI) of the brain were negative for air embolism. Laboratory work up was normal. The patient underwent 5 hours of hyperbaric chamber therapy. Esophagogastroduodenoscopy (EGD) showed hemorrhagic gastropathy and mild duodenal bulb erosions (Image 2). The patient was treated with 72 hours of intravenous (IV) proton pump inhibitor (PPI) and had an uncomplicated hospital course. After 3 days, he was able to tolerate oral intake and was discharged with PPI treatment. We report a case of extensive portal vein gas to shed a light to the importance of reporting such cases, so we can have a better understanding of different presentations and its treatment.Figure: Abdominal Computed tomography (CT) scan showing extensive portal venous gas throughout the liver.Figure: Esophagogastroduodenoscopy (EGD) showing Hemorrhagic gastropathy and duodenal bulb erosions.