Sebastian Hermida Velasquez, DO1, Abelardo Broceta-Martinez, MD2, Thatcher T. Huynh, DO2, Joseph W.. Caravella, DO3, Natalia Martin, DO4, Carlos M.. Ramos Pachon, MD5, William Rengifo, MD5 1Palmetto General Hospital, Hialeah, FL; 2Larkin Community Hospital, Hialeah, FL; 3Larkin Community Hospital, Miami, FL; 4Larkin Community Hospital, South Miami, FL; 5University of Miami Miller School of Medicine at Jackson Memorial Hospital, Miami, FL Introduction: Hydrogen peroxide is simple household item that when ingested can lead to life-threatening events. This case highlights two complications of Hydrogen Peroxide ingestion; directly related to oxygen gas embolism and direct caustic injury. While gastrointestinal necrosis and pneumatosis are common after consumption, portal vein thrombosis (PVT) and esophageal perforation are rare. We present a case of Hydrogen Peroxide ingestion resulting in both of these complications, requiring diverse multidisciplinary management.
Case Description/
Methods: A 23-year-old female with no past medical history, presented after Hydrogen Peroxide ingestion; notable associated symptoms of nausea, vomiting, and severe odynophagia. Initial CT abdomen revealed diffuse gastric/duodenal wall thickening with adjacent inflammatory fat stranding. The patient underwent an EGD which was notable for esophagitis with severe stenosis, duodenitis and superficial necrotic changes at the level of D1,D2 and D3. Due to extensive esophageal damage, she underwent stenting to protect the friable mucosa after severe caustic injury. The patient resumed PPI and sucralfate regimen. Throughout the course of the hospitalization, she developed worsening dyspnea and right upper quadrant pain. Repeat CT imaging now revealing a new onset PVT extending into the superior mesenteric vein; this event likely occurring in the setting of oxygen gas embolism, prompting immediate anticoagulation. This imaging was also able to identify a distal esophageal perforation subsequently treated with an esophagectomy, cervical esophagostomy and feeding jejunostomy. Four months later, the patient's intestinal continuity was restored via transverse colonic interposition graft. Discussion: This case highlights two rare complications of hydrogen peroxide ingestion. PVT likely occurred due to hydrogen peroxide intoxication; high levels of oxygen exceeded the maximum blood solubility, developing a venous embolism responsible for portal venous gas and pneumatosis. The perforation found on serial imaging demanded immediate surgical intervention due to irreversible tissue damage. Of note, given the endoscopic stenting failure to protect the fragile mucosa, one should keep in mind the limitations of minimally invasive procedures in advanced caustic injury. Given these complications, this case encourages clinicians to consider caustic ingestion in the differential for any unexplained PVT and acute esophageal injury, specifically in the young and healthy patient population.
Figure: Left: Friable, necrotic esophageal mucosa with severe stenosis on endoscopy following hydrogen peroxide ingestion. Right: Esophageal stent placement for attempted mucosal preservation, which ultimately failed due to progressive perforation requiring surgical intervention.
Figure: CT angiography (coronal view) demonstrating extensive portal vein thrombosis (PVT) at the portosplenic confluence with complete occlusion of the superior mesenteric vein (SMV) and partial occlusion of an SMV branch.
Disclosures: Sebastian Hermida Velasquez indicated no relevant financial relationships. Abelardo Broceta-Martinez indicated no relevant financial relationships. Thatcher Huynh indicated no relevant financial relationships. Joseph Caravella indicated no relevant financial relationships. Natalia Martin indicated no relevant financial relationships. Carlos Ramos Pachon indicated no relevant financial relationships. William Rengifo indicated no relevant financial relationships.
Sebastian Hermida Velasquez, DO1, Abelardo Broceta-Martinez, MD2, Thatcher T. Huynh, DO2, Joseph W.. Caravella, DO3, Natalia Martin, DO4, Carlos M.. Ramos Pachon, MD5, William Rengifo, MD5. P2893 - Hydrogen Peroxide Ingestion Causing Portal Vein Thrombosis and Esophageal Perforation, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
