Gastrotomy--a surgical approach to iron overdose

Emesis and lavage often are ineffective in providing complete emptying of the stomach after an ingestion. With a locally corrosive and systemically toxic agent such as iron, surgical intervention with emergency gastrotomy may be required. We recently treated a 19-year-old man in the ED and in the departments of surgery and medicine who required a gastrotomy to remove a large amount of elemental iron inaccessible to removal by emesis, lavage, or gastroscopy. At gastrotomy the stomach showed full-thickness inflammation; the entire mucosal surface was hemorrhagic in nature. Gastrotomy was successful in allowing the removal of a large amount of the retained corrosive material. The severity of the findings at gastrotomy and the dramatic clinical improvement and recovery in our patient strongly support this approach if traditional methods fail.