A Case Report of; Pesticide ingestion, complicated by Esophageal strictures WITH Suspicion of TE-Fistula... Radiologic Features and the following surgery..

1. CASE REPORT OF;
PESTICIDE INGESTION, COMPLICATED BY
ESOPHAGEAL STRICTURES
Adnan Rashid, MD
Department of Radiology SIMS/SHL

2. HISTORY
H/O Pesticide (reportedly an
Organophosphate compound) intake 3
months ago
C/O Cough with oral intake
Pt is NPO since then, Feeds through G-
tube

3. OESOPHAGOSCOPY:
MULTIPLE TRACHEO-ESOPHAGEAL
FISTULAE
BROCHOSCOPY:
NO EVIDENCE OF TE FISTULA

4. INITIAL BARIUM
SWALLOW :
SEVERE NARROWING
OF ESOPHAGUS
BRONCHOGRAM ON
LEFT HEMITHORAX
DUE TO SPILL OF
CONTRAST INTO
RESPIRATORY TRACT.

5. Barium swallow
(oblique view):
Severe narrowing of
esophagus
Contrast outlining
the tracheo-
bronchial tree, due
to spill of contrast
into respiratory tract
(Contrast Aspiration)

6. Barium swallow
(Lateral view):
Severe narrowing of
esophagus
Contrast outlining
the larynx and
tracheo-bronchial
tree, due to spill of
contrast into
respiratory tract
(Contrast Aspiration)

7. PLAIN CT CHEST FEW DAYS AFTER BARRIUM SWALLOW, SHOWING RESIDUAL CONTRAST IN
ESOPHAGEAL WALL, NARROWING OF THE TRACHEO-ESOPHAGEAL STRIP..

8. IRREGULARITY IN THE WALL OF ESOPHAGUS, WITH
SUSPICION OF BREACH POSTERIOR TO THE TRACHEAL WALL

11. CT- BROCHOGRAM IN RIGHT BROCHUS
SECONDARY TO ASPIRATION

12. Saggital CT with oral
Barium:
Severe stricture in upper
esophagus with holdup
of contrast in the
oropharynx.
Reflux into naso-pharynx
and upper airway
aspiration.

13. OPERATED

15. REVIEW

16.  Asian Cardiovasc Thorac Ann. 2008 Aug;16(4):298-300.
 Esophageal injuries due to aluminum phosphide tablet poisoning
in India.
 Darbari A1, Tandon S, Chaudhary S, Bharadwaj M, Kumar A, Singh GP.
 Author information
 Abstract
 Aluminum phosphide is a lethal systemic poison with 80%-90%
mortality. Survivors have taken either a very small amount or the tablet
had been exposed to air, rendering it less toxic, but often causing severe
esophageal injuries. The presentation and treatment of 11 cases of
esophageal injury due to aluminum phosphide are described. Ten
patients had esophageal stricture, and 1 had tracheoesophageal fistula
with stricture. Endoscopic bougie dilatation was sufficient in 7 patients,
and surgical intervention was required in 4 who underwent definitive
repair via gastric tube or feeding jejunostomy with a 2(nd) stage repair
planned in 2. There was no mortality but significant morbidity. Mortality
and morbidity might be prevented by withdrawing this pesticide from the
market, making its sale difficult, or modifying the packaging.
 PMID: 18670022 [PubMed - indexed for MEDLINE]

17. SPECTRUM OF CORROSIVE ESOPHAGEAL INJURY AFTER INTENTIONAL PARAQUAT OR GLYPHOSATE-
SURFACTANT HERBICIDE INGESTION
HSIAO-HUI CHEN,1 JA-LIANG LIN,1 WEN-HUNG HUANG,1 CHENG-HAO WENG,1 SHEN-YANG LEE,1 CHING-WEI HSU,1
KUAN-HSING CHEN,1 I-KUAN WANG,2 CHIH-CHIA LIANG,2 CHIZ-TZUNG CHANG,2 AND TZUNG-HAI YEN1
AUTHOR INFORMATION ► COPYRIGHT AND LICENSE INFORMATION ►
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES IN PMC.
 Abstract
 Background
 Data on the spectrum of corrosive injury to the esophagus after paraquat or glyphosate-surfactant ingestion are sparse in
the literature and confined to case studies and brief reports. Therefore, this study aimed to examine the clinical features,
degrees of esophageal injury, and clinical outcomes after paraquat or glyphosate herbicide ingestion, and sought to
determine what association, if any, may exist between these findings.
 Methods
 We performed an observational study on 47 patients with paraquat or glyphosate ingestion who underwent endoscopic
evaluation over a period of 11 years (2000–2011).
 Results
 Corrosive esophageal injuries were classified as grade 1 in 14 (glyphosate-surfactant) and three (paraquat), grade 2a in
nine (glyphosate-surfactant) and 18 (paraquat), and grade 2b in one (glyphosate-surfactant) and two (paraquat) patients.
No patients had grade 0, 3a, or 3b esophageal injuries. Therefore, the severity of corrosive injury was more severe in the
paraquat group (P = 0.005). After toxin ingestion, systemic toxicity occurred, with rapid development of systemic
complications in many cases. Neurologic complications occurred more frequently in the glyphosate-surfactant group
(29.2% versus 0%, P = 0.005), although respiratory failure (4.2% versus 34.8%, P = 0.008), hepatitis (12.5% versus
52.2%, P = 0.004), and renal failure (20.8% versus 52.2%, P = 0.025) developed more frequently in the paraquat group.
Patients with glyphosate poisoning had shorter hospital stays than patients with paraquat poisoning (13.3 ± 15.1 days
versus 26.8 ± 10.2 days, P = 0.001). Nevertheless, there was no significant difference in mortality rate between the
glyphosate-surfactant and paraquat groups (8.3% versus 13.0%, P = 0.601). We ultimately found that patients with grade
2b esophageal injury suffered from a greater incidence of respiratory (100.0% versus 5.9%, P = 0.001) and
gastrointestinal (66.7% versus 11.8%, P = 0.034) complications than patients with grade 1 injury, regardless of herbicide
type.
 Conclusion
 Paraquat and glyphosate are mild caustic agents that produce esophageal injuries of grades 1, 2a, and 2b only. Our data
also suggest a potential relationship between the degree of esophageal injury and systemic complications.

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