Laparoscopic appendectomy for elemental mercury sequestration in the appendix: A case report

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: Appendectomy; Appendix; Case report; Mercury ingestion; Mercury poisoning; Mercury retention.

Figure 1

Abdominal X-ray 16 d after the elemental mercury ingestion showing a lot of radiopaque particles along gastrointestinal tract, mostly in colon with obvious sequestration in the appendix.

Figure 2

X-ray of the abdomen after several enemas showing almost no remnant of elemental mercury in gastrointestinal tract except sequestration of mercury in the appendix.

Figure 3

Specimen of the appendix after laparoscopic appendectomy. A: Intact specimen; B: After the incision elemental mercury showed and spilled out of the lumen of the appendix.