Mercury Bichloride Iatrogenic Poisoning: A Case Report

Abstract

Introduction: Inorganic mercury intoxication is rare and usually the result of occupational exposure, suicide attempt or accident. This article presents the case of acute poisoning due to peritoneal lavage with mercury bichloride. Case report: A 30 year old woman was operated in order to remove a teratoma from her right ovary. On the second postoperative day she presented ileus, renal failure and circulatory collapse. Because of the severity of her situation she underwent an exploratory laparotomy the day after. Intraoperative findings included white necrotic lesions on the anterior surface of the sigmoid colon, dark colored intraperitoneal fluid collection and a bluish micronodular lesion of the omentum. The ovaries, uterus and fallopian tubes were unaffected. The patient was admitted to the ICU and was started on Continuous Veno Venous Hemo Diafiltration (CVVHDF). The doctors who treated her contacted the Poison Information Centre for consultation, posing the question whether her clinical condition could be attributed to the use of mercury bichloride for peritoneal wash during the first operation. A peritoneal lavage with mercury bichloride was conducted in order to avoid cancer cell implantations on healthy tissue. Having suspected poisoning from systemic absorption, mercury levels were measured in patient’s serum and urine. The results confirmed the poisoning since the serum level was 950 mcg/l and the urine level was 550 mcg/l (normal values: <10 mcg/l and <20 mcg/l respectively). The patient was started on chelation therapy (initially BAL and subsequently succimer). The therapy was successful and the patient was discharged with orders to continue therapy with succimer and reevaluation appointment in 15 days. The patient missed her appointment and discontinued her therapy. She was readmitted three months later with seizures. The laboratory tests revealed increased levels of mercury and therapy with succimer was restarted. Two months later she was asymptomatic and in good clinical condition. Conclusion: Old treatment methods are rarely still in use and may cause serious problems. This is, to our knowledge, the only case report of mercury poisoning due to peritoneal lavage with mercury bichloride the last thirty years.