Journal of Medical Toxicology

, Volume 9, Issue 3, pp 270–273

Intraperitoneal Elemental Mercury Exposure from a Mercury-Weighted Bougie

  • Maryann Mazer-Amirshahi
  • Margit L. Bleecker
  • Fermin BarruetoJr.
Toxicology Observation

DOI: 10.1007/s13181-013-0303-1

Cite this article as:
Mazer-Amirshahi, M., Bleecker, M.L. & Barrueto, F. J. Med. Toxicol. (2013) 9: 270. doi:10.1007/s13181-013-0303-1



Significant exposure to elemental mercury can occur if a mercury-weighted medical device is damaged during use. We report a case of an elemental mercury spill into the peritoneum of a patient undergoing laparoscopic gastric bypass surgery.

Case Report

A 64-year-old man with multiple comorbidities underwent an elective Roux-en-Y gastric bypass procedure for the treatment of morbid obesity. A mercury-weighted esophageal bougie was inadvertently used during construction of the anastomosis. A suture placed through the distal tip of the device caused elemental mercury to leak into the peritoneum. Two days later, the patient underwent another surgical procedure for removal of the mercury. Intermittent air measurements taken from the laparoscope exhaust showed a peak intraperitoneal mercury concentration of 98,169 ng/m3. Blood mercury levels peaked at 146 μg/L on day 22 after the exposure, and urine mercury concentrations peaked on day 43 at 227 μg/L. The patient had no evidence of acute toxicity, but he was found to have proteinuria on follow-up evaluation.


Patients can be exposed inadvertently to toxic amounts of elemental mercury when the integrity of medical devices is compromised. We encourage hospitals to discontinue the use of devices that contain mercury. Effective alternatives that do not pose exposure risks to patients or health care workers are readily available.


MercuryPeritoneal exposureBougie

Copyright information

© American College of Medical Toxicology 2013

Authors and Affiliations

  • Maryann Mazer-Amirshahi
    • 1
    • 2
    • 6
  • Margit L. Bleecker
    • 3
  • Fermin BarruetoJr.
    • 4
    • 5
  1. 1.The George Washington UniversityWashingtonUSA
  2. 2.Children’s National Medical CenterWashingtonUSA
  3. 3.Center for Occupational and Environmental NeurologyBaltimoreUSA
  4. 4.Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  5. 5.Department of Emergency MedicineUpper Chesapeake HealthBel AirUSA
  6. 6.WashingtonUSA