Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Abstract

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy.

Keywords: abdomen; acute; attempted; caustics; laparotomy; peritonitis; suicide; sulfuric acid.

Figure 1

Computerized tomography scan showing the presence of marked pneumoperitoneum and discreet intra-abdominal free fluid, more evident in the upper quadrants, with air–fluid level in the right upper quadrant.