Fibrous stricture of the stomach due to iron (feosol) poisoning; report of a case and brief review of the literature.

Abstract

Iron poisoning in children has been reported with increasing frequency in recent years. Most of the cases have resulted from accidental ingestion of ferrous sulfate tablets, many of which are of attractive color and taste, which appeal to children. The acute symptoms of iron poisoning are now well known. They may begin thirty to sixty minutes after ingestion; with less soluble products, damage may be delayed as long as twenty-four hours. The symptoms are vomiting, diarrhea, dehydration, shock, and coma. Severe acidosis has been reported in some cases. Dehydration, shock, and acidosis have resulted in death in about half of the reported cases. The usual treatment includes gastric lavage, cathartics, enemas, intravenous fluids, plasma, and blood. At autopsy the most striking lesions are seen in the gastrointestinal tract, consisting in mucosal necrosis, congestion, and focal hemorrhages. Hepatic and renal lesions are also noted. Davis and Gibbs recently reported a case in which a necrotic segment of gastrointestinal mucosa was passed per rectum. Less familiar than the acute symptoms of iron poisoning mentioned above is the occurrence of fibrous stricture of the pylorus and stomach, occurring as a late complication. Up to the present time, 5 such cases have appeared in the British literature. Crosskey reported in 1952 what he believed was the first case of pyloric stenosis as a complication of ferrous sulfate poisoning to be published in Great Britain. Since that time, Forshall and Rickham have reported 2 cases of pyloric obstruction due to ferrous sulfate, Elliot-Smith and Davies have reported 1 case, and Ross has reported a case of pyloric stenosis and fibrous stricture of the stomach. In the British cases symptoms of gastric or pyloric stricture did not develop until ten days to six weeks after iron ingestion. The patients usually were seen with the complaint of vomiting one to two months after the accident. Four of the 5 did well after operations, which included 2 Mikulicz procedures, 1 posterior gastrojejunostomy, and 1 gastric resection with a Billroth I anastomosis. The fifth patient died as a result of acute peritonitis following a jejunostomy. Report of Case M. M., a two-and-a-half-year-old Negro girl, was admitted to Denver General Hospital on July 23, 1956, following the ingestion of an undetermined number of “Feosol” pills. Her mother found her shortly before admission, after she had vomited some green pills. At the time of admission, the child was semicomatose, arousing herself only for brief periods during gastric lavage (with sodium bicarbonate). She received 250 c.c. of whole blood on admission and was given antibiotics. For the first five days in the hospital she was maintained on fluids administered intravenously. Initially she ran a febrile course with bouts of abdominal distention. An abdominal roentgenogram was compatible with paralytic ileus.