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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 6  |  Page : 688
Emphysematous gastritis with intrahepatic portal venous gas in aluminium phosphide intoxication: A rare radiological presentation


Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication6-Sep-2014
 

How to cite this article:
Gorsi U, Bhatia A, Singh T, Khandelwal N. Emphysematous gastritis with intrahepatic portal venous gas in aluminium phosphide intoxication: A rare radiological presentation. Ann Trop Med Public Health 2013;6:688

How to cite this URL:
Gorsi U, Bhatia A, Singh T, Khandelwal N. Emphysematous gastritis with intrahepatic portal venous gas in aluminium phosphide intoxication: A rare radiological presentation. Ann Trop Med Public Health [serial online] 2013 [cited 2019 Dec 12];6:688. Available from: http://www.atmph.org/text.asp?2013/6/6/688/140276
Dear Sir,

Aluminum phosphide (ALP) is used as a rodenticide, fumigant, and insecticide for stored cereal grains in many countries around the world. It is evidently poisonous and has been used for suicidal purposes also. ALP on exposure to moisture liberates phosphine gas, which spreads hematogenously and leads to multisystem toxicity. [1],[2] The cytotoxic phosphine gas mainly affects the heart, lungs, gastrointestinal tract, and kidneys, but can involve any organ in the body. [1]

In the Indian subcontinent also, ALP is considered a wide scale problem. [3],[4] We hereby would like to share a case of ALP intoxication from this part of world with unusual radiological gastrointestinal complications. The index patient presented with severe abdominal pain following ALP intoxication. Contrast-enhanced computed tomography (CECT) of abdomen showed intramural gas in the stomach wall suggestive of emphysematous gastritis with associated gas in the intrahepatic portal venous branches located predominantly along the periphery in a radial fashion. In addition, multiple hypodense lesions were also seen in the spleen suggestive of infarcts likely due to dissemination of air emboli in the portal circulation [Figure 1]. No definite air foci, however, were seen either in splenic artery or vein. The patient succumbed to death after few hours due to refractory shock. To best of our knowledge, these unusual and ominous radiological manifestations have not been demonstrated and described previously with ALP intoxication.
Figure 1: Coronal (a and b) and axial (c) multiplanar reformatted (MPR) CECT images showing air dissecting within the thickened gastric wall (white arrows in a). Multiple intrahepatic air foci (black arrows in a and b) seen, arranged in a radial fashion predominantly along the periphery. Also noted are multiple hypodense areas in the spleen (white arrows in c).

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   References Top

1.Gupta S, Ahlawat SK. Aluminium phosphide poisoning-A review. J Toxicol Clin Toxicol 1995;33:19-24.  Back to cited text no. 1
    
2.Wahab A, Zaheer MS, Wahab S, Khan RA. Acute aluminium phosphide poisoning: An update. Hong Kong J Emerg Med 2008;15:152-5.  Back to cited text no. 2
    
3.Siwach SB, Gupta A. The profile of acute poisonings in Haryana-Rohtak Study. J Assoc Physicians India 1995;43:756-9.   Back to cited text no. 3
    
4.Singh D, Jit I, Tyagi S. Changing trends in acute poisoning in Chandigarh zone: A 25-year autopsy experience from a tertiary care hospital in northern India. Am J Forensic Med Pathol 1999;20:203-10.  Back to cited text no. 4
    

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Correspondence Address:
Ujjwal Gorsi
Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.140276

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