Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2019; 7(9): 1038-1042
Published online May 6, 2019. doi: 10.12998/wjcc.v7.i9.1038
Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report
Gregor Norčič, Žan Čebron, Primož Sever, Jan Grosek, Aleš Tomažič
Gregor Norčič, Žan Čebron, Primož Sever, Jan Grosek, Aleš Tomažič, Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana SI-1000, Slovenia
Author contributions: Norčič G contributed to study conception and design; Čebron Ž contributed to collection of data, analysis and interpretation of data; Grosek J and Sever P contributed to drafting of manuscript; Tomažič A contributed to critical revision; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient before the surgery for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interests with regard to this case report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gregor Norčič, MD, PhD, Surgeon, Consultant, Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana SI-1000, Slovenia. gregor.norcic@kclj.si
Telephone: +386-15-224788 Fax: +386-15-224788
Received: January 8, 2019
Peer-review started: January 8, 2019
First decision: January 26, 2019
Revised: February 1, 2019
Accepted: February 18, 2019
Article in press: February 18, 2019
Published online: May 6, 2019
Abstract
BACKGROUND

Despite negligible absorption of elemental mercury after acute ingestion, retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix, managed by laparoscopic appendectomy.

CASE SUMMARY

A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal (GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures. Consequently, following deliberations by an interdisciplinary team of specialists, laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful.

CONCLUSION

Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.

Keywords: Mercury poisoning, Appendix, Mercury ingestion, Mercury retention, Appendectomy, Case report

Core tip: Despite negligible absorption of elemental mercury after acute ingestion, retention in the appendix with subsequent local and systemic complications is possible. The question of whether or not to perform appendectomy in an asymptomatic patient remains open. We present a case of elemental mercury sequestration in the appendix, managed by laparoscopic appendectomy in order to prevent possible complications. Given the limited evidence regarding the optimal management approach for patients with retained mercury, the choice of treatment strategy should be determined on a case-by-case basis by a multidisciplinary team.