Case Report: Delayed gastrointestinal structural complications requiring surgery following massive paint thinner...

Paint thinners, which contain volatile aromatic hydrocarbons like toluene and xylene, are primarily associated with acute systemic toxicity (e.g., central nervous system depression, metabolic acidosis) following inhalation. Case reports detailing severe, delayed gastrointestinal (GI) structural complications in adults after massive oral ingestion, which necessitate extensive surgical intervention, remain exceedingly rare in the medical literature.

A 68-year-old male with a history of hypertension and chronic alcoholism presented 8 h after mistakenly ingesting approximately 500 mL of paint thinner while intoxicated. On admission, the patient exhibited stupor, hypotension (74/49 mmHg), bradycardia (75 bpm), hypothermia (34.0 °C), and significant hematochezia. Though systemic symptoms stabilized after initial intensive care, he developed recurrent, refractory episodes of ileus over the following 3 weeks, despite conservative management. Abdominal computed tomography (CT) scans revealed multisegmental wall thickening and lumen stricture in the distal jejunum and ileum, suggestive of enteritis or inflammatory bowel disease. Surgical exploration on Hospital Day (HD) 27 confirmed the progression to irreversible structural damage, revealing severe adhesion, a continuous global stricture in the terminal ileum (extending approximately 80 cm from the ileocecal valve), a skip lesion stricture proximally, and a suspected ileocecal fistula. An ileocecectomy was performed after resection of a 132 cm segment of small bowel. Pathology confirmed chronic, transmural inflammation and ulceration.

This case demonstrates that massive oral paint thinner ingestion can bypass typical protective mechanisms, leading to severe, delayed, and localized structural GI failure, particularly in the terminal ileum. In patients who present with progressive mechanical sequelae (refractory ileus and hematochezia) following massive hydrocarbon ingestion, a high index of suspicion for developing chronic structural lesions is warranted, suggesting that timely surgical intervention may be critical to expedite patient recovery.