Ultrasound Guided Percutaneous Transhepatic Gall bladder Aspiration (PTGBA) in the Treatment of Mushroom Poisoning

Abstract

Mushroom poisonings (Mycetismus) are rare conditions have been reported frequently from North East India during the monsoon seasons. In one of the earlier studies we noted a high mortality (43.75%) even after using all the conventional agents in literature. Studies in dogs have shown that the toxins are excreted in the bile and much of the toxin excreted in this way is reabsorbed into the liver with the bile. Interruption of the cycling of the toxin by bile duct cannulation can reduce the toxic effects of α-amantin in dogs. We report three males, (58, 28 and 24 years old respectively) who came to our institute with mushroom poisoning presenting with dehydration, acute liver failure, raised liver enzymes and hyperbilirubinemia. Though they were given conventional treatment their raised liver enzymes indicated high risk for mortality. After proper consent, ultrasound guided percutaneous transhepatic gall bladder aspiration (UPTGA) was performed in all three of them under strict aspeptic and antiseptic conditions. Bile was aspirated and preserved for toxicological analysis. The patients improved both symptomatically and biochemically after the procedure. No complications were noted in these patients and they were discharged after a few days of observation in our hospital. We conclude that ultrasound guided percutaneous transhepatic Gall bladder Aspiration (PTGBA) is a simple bedside procedure that can be safely done in high risk patients of amanita mushroom poisoning.