Systemic mercury intoxication following rupture of a Miller-Abbott tube

Following rupture of a Miller-Abbott tube mercury bag a 39-year old woman, postoperative for resection of the right colon for diverticulosis and diverticulitis, developed signs and symptoms of systemic mercury intoxication. A small bowel fistula allowed the metallic mercury to aggregate in retroperitoneal tissues setting up an environment which was conductive to conversion of metallic mercury to divalent mercury, an absorbable product. Analysis of brain, kidney and urine following her demise showed markedly elevated mercury levels. To our knowledge this is the only reported case of such a complication. Clinicians should be wary of elemental mercury in the gastrointestinal tract in patients with suspected or proven enteric fistulas.