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Delayed-Onset Portal Venous Thrombosis After Ingestion of 3% Hydrogen Peroxide. | LitMetric

Delayed-Onset Portal Venous Thrombosis After Ingestion of 3% Hydrogen Peroxide.

J Emerg Med

Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego Health System, San Diego, California.

Published: November 2021

AI Article Synopsis

  • Portal venous gas can appear on imaging after someone ingests hydrogen peroxide, and hyperbaric therapy is usually used to prevent brain complications, even if gastrointestinal symptoms resolve.
  • A case is reported where a patient developed portal venous thrombosis after consuming 3% hydrogen peroxide but was managed without hyperbaric therapy, which is an unusual complication not previously documented.
  • Emergency physicians need to recognize that portal venous gas may be present without central nervous system symptoms and that delayed thrombosis can occur, which is important for treatment decisions.

Article Abstract

Background: Identification of portal venous gas on radiographic imaging is well documented after the ingestion of hydrogen peroxide, as is its resolution after hyperbaric therapy. Although hyperbaric therapy may resolve the gastrointestinal symptoms associated with the presence of portal venous gas, the principle rationale for performing hyperbaric therapy is to prevent subsequent central nervous system oxygen embolization.

Case Report: We describe a patient with portal venous gas identified by computed tomography after the ingestion of 3% hydrogen peroxide, managed without hyperbaric therapy, who subsequently developed portal venous thrombosis. We are not aware of this complication being previously described from hydrogen peroxide ingestion. The case is complicated by the coexistence of a self-inflicted stab wound, leading to exploratory laparotomy in a patient predisposed to arterial vascular occlusion. Why Should an EmergencyPhysicianBeAware of This? Emergency physicians will encounter patients after the ingestion of hydrogen peroxide who, despite not having symptoms of central nervous system emboli, have portal venous gas identified on radiographic imaging. Being aware that the principle rationale for prophylactic utilization of hyperbaric therapy is to prevent subsequent central nervous system emboli, and that in at least one case, delayed-onset portal venous thrombosis has occurred without hyperbaric therapy may help contribute to clinical decision-making.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jemermed.2021.07.051DOI Listing

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