A Case of Numerous Small Intestinal Ulcers and Perforations Caused by Ingesting Surface Active Agents

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 18; no. 5; pp. 202 - 207
• Main Authors: Osaka, Itaru, Mitsusada, Makoto, Wakayama, Tatsurou, Matsuura, Atsushi, Arai, Hiroshi, Yokoyama, Haruko, Tanaka, Michio
• Format: Journal Article
• Language: English; Japanese
• Published: Japanese Association for Acute Medicine 15.05.2007
• Subjects: drug poisoning; mild detergent; small intestinal bleeding; vasopressin
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.18.202

We report a case in which ingestion of surface active agents caused numerous small intestinal ulcers and perforations. The 45-year-old male patient, who attempted suicide by ingesting large amounts of surface active agents, was admitted to our hospital with acute drug poisoning. The patient presented with melena and complained of continuous pain in the right lower abdomen during his clinical course. Various examinations including endoscopy and abdominal angiography suggested that the haemorrhage originated from ulcers of the small intestine. Treatment was therefore started with continuous arterial infusion of vasopressin, which temporarily controlled the bleeding. Symptoms of peritonitis then appeared and melena recurred. We suspected perforative peritonitis caused by small intestinal ulcers and performed emergency ileocecal resection, leaving 1.6m of jejunum. Melena persisted after the operation, seeming to originate from ulcers of the residual small intestine. However, examinations detected no clear source of bleeding, The patient's symptoms improved with conservative treatment and he was discharged from the hospital 55 days after surgery. When a patient suffers from intoxication caused by surface active agents, in most cases toxic symptoms improve with excretion through the intestine. However, as in the present case, serious conditions triggered by factors such as intestinal stasis as a result of obstruction can occur, and such patients should be very carefully monitored and observed.