Upper Gastrointestinal Bleeding in Aluminium Phosphide Poisoning

Area of Science:

• Toxicology
• Gastroenterology
• Forensic Medicine

Background:

• Aluminium phosphide (AlP) is a widely used pesticide and a common agent for intentional self-harm in India.
• While cardiac toxicity is a well-documented acute effect, severe gastrointestinal complications are infrequently reported.
• This study focuses on a rare presentation of AlP toxicity involving the upper gastrointestinal tract.

Observation:

• A 30-year-old male presented with massive upper gastrointestinal bleeding on the second day after ingesting aluminium phosphide.
• The patient underwent exploratory laparotomy, adhesinolysis, gastrostomy closure, and feeding jejunostomy placement.
• Despite medical intervention, the patient succumbed to the complications eight days post-ingestion.

Findings:

• Autopsy revealed findings consistent with severe corrosive injury to the gastrointestinal system.
• The case underscores the potential for delayed, severe gastrointestinal hemorrhage as a consequence of aluminium phosphide ingestion.
• Literature review supports the corrosive nature of aluminium phosphide on the GI mucosa, though massive bleeding is a rare complication.

Implications:

• This case highlights the need for increased awareness of severe gastrointestinal complications in aluminium phosphide poisoning.
• Clinicians should consider the possibility of corrosive gastrointestinal injury in patients presenting with delayed bleeding after AlP ingestion.
• Further research into the mechanisms and management of AlP-induced gastrointestinal toxicity may improve patient outcomes.