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Upper Gastrointestinal Bleeding in Aluminium Phosphide Poisoning.

C Behera¹, K Krishna¹, S Arava²

¹Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi-110029, India.

Kathmandu University Medical Journal (KUMJ)

|February 16, 2018

Summary

Aluminium phosphide (AlP) poisoning, common in India, rarely causes severe gastrointestinal bleeding. This case highlights a fatal instance of upper GI hemorrhage following AlP ingestion, emphasizing its corrosive potential.

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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.