Advertisement

Dysphagia

, Volume 25, Issue 4, pp 271–276 | Cite as

Esophageal Complications Following Aluminium Phosphide Ingestion: An Emerging Issue Among Survivors of Poisoning

  • Rajendra K. Jain
  • Narendra B. Gouda
  • Virendra K. Sharma
  • Tribhuvan N. Dubey
  • Atul Shende
  • Rajesh Malik
  • Gurudutt Tiwari
Original Article

Abstract

Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary–Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow–cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary–Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered.

Keywords

Aluminium phosphide Poisoning Dysphagia Esophagus-stricture/fistula Deglutition Deglutition disorders 

References

  1. 1.
    Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol. 2005;24(6):279–85.CrossRefPubMedGoogle Scholar
  2. 2.
    Dieterich WH, Mayr G, Hild K, Sullivan JB, Murphy J. Hydrogen phosphide as a fumigant for foods, feeds and processed food products. Residue Rev. 1967;19:135–49.PubMedGoogle Scholar
  3. 3.
    Singh S, Singh D, Wig N, Jit I, Sharma BK. Aluminum phosphide ingestion—a clinico-pathologic study. J Toxicol Clin Toxicol. 1996;34(6):703–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Moghadamnia AA, Abdollahi M. An epidemiological study of poisoning in northern Islamic Republic of Iran. East Mediterr Health J. 2002;8:88–94.PubMedGoogle Scholar
  5. 5.
    Abder-Rahman HA, Battah AH, Ibraheem YM, Shomaf MS, el-Batanch N. Aluminium phosphide fatalities, new local experience. Med Sci Law. 2000;40:164–8.PubMedGoogle Scholar
  6. 6.
    Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J. 2006;23(1):e3.CrossRefPubMedGoogle Scholar
  7. 7.
    Singh S, Bhalla A, Verma SK, Kaur A, Gill K. Cytochrome-c oxidase inhibition in 26 aluminum phosphide poisoned patients. Clin Toxicol (Phila). 2006;44(2):155–8.Google Scholar
  8. 8.
    Chugh SN, Arora V, Sharma A, Chugh K. Free radical scavengers & lipid peroxidation in acute aluminium phosphide poisoning. Indian J Med Res. 1996;104:190–3.PubMedGoogle Scholar
  9. 9.
    Singh RB, Rastogi SS, Singh DS. Cardiovascular manifestations of aluminium phosphide intoxication. J Assoc Physicians India. 1989;37(9):590–2.PubMedGoogle Scholar
  10. 10.
    Aggarwal P, Handa R, Wig N, Biswas A, Saxena R, Wali JP. Intravascular hemolysis in aluminium phosphide poisoning. Am J Emerg Med. 1999;17(5):488–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Chittora MD, Meena SR, Gupta DK, Bhargava S. Acute hepatic failure in aluminium phosphide poisoning. J Assoc Physicians India. 1994;42(11):924.PubMedGoogle Scholar
  12. 12.
    Chhina RS, Thukral R, Chawla LS. Aluminum phosphide-induced gastroduodenitis. Gastrointest Endosc. 1992;38(5):635–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Hajouji Idrissi M, Oualili L, Abidi K, Abouqal R, Kerkeb O, Zeggwagh AA. Severity factors of aluminium phosphide poisoning (Phostoxin). Ann Fr Anesth Reanim. 2006;25(4):382–385 [in French].Google Scholar
  14. 14.
    Chugh SN, Arora V, Kaur S, Sood AK. Toxicity of exposed aluminium phosphide. J Assoc Physicians India. 1993;41(9):569–70.PubMedGoogle Scholar
  15. 15.
    Chugh SN, Kamar P, Sharma A, Chugh K, Mittal A, Arora B. Magnesium status and parenteral magnesium sulphate therapy in acute aluminum phosphide intoxication. Magnes Res. 1994;7(3–4):289–94.PubMedGoogle Scholar
  16. 16.
    Khosla SN, Nand N, Kumar P, Trehan V. Muscle involvement in aluminium phosphide poisoning. J Assoc Physicians India. 1988;36(4):289–90.PubMedGoogle Scholar
  17. 17.
    Dave HH, Dave TH, Rakholia VG, Kharod PN, Jaju HJ. Delayed hemorrhagic stroke following accidental aluminium phosphide ingestion. J Assoc Physicians India. 1994;42(1):78–9.PubMedGoogle Scholar
  18. 18.
    Nijhawan S, Rastogi M, Tandon M, Mathur A, Rai RR. Aluminum phosphide-induced esophageal stricture: an unusual complication. Endoscopy. 2006;38(Suppl 2):E23.CrossRefPubMedGoogle Scholar
  19. 19.
    Madan K, Chalamalasetty SB, Sharma M, Makharia G. Corrosive-like strictures caused by ingestion of aluminium phosphide. Natl Med J India. 2006;19(6):313–4.PubMedGoogle Scholar
  20. 20.
    Talukdar R, Singal DK, Tandon RK. Aluminium phosphide-induced esophageal stricture. Indian J Gastroenterol. 2006;25(2):98–9.PubMedGoogle Scholar
  21. 21.
    Kapoor S, Naik S, Kumar R, Sharma S, Pruthi HS, Varshney S. Benign esophageal stricture following aluminium phosphide poisoning. Indian J Gastroenterol. 2005;24(6):261–2.PubMedGoogle Scholar
  22. 22.
    Misra SP, Dwivedi M. Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures. J Clin Gastroenterol. 2009;43(5):405–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Darbari A, Tandon S, Chaudhary S, Bharadwaj M, Kumar A, Singh GP. Esophageal injuries due to aluminum phosphide tablet poisoning in India. Asian Cardiovasc Thorac Ann. 2008;16(4):298–300.PubMedGoogle Scholar
  24. 24.
    Somani SK. Aluminium phosphide-induced esophageal stricture palliation with polyflex stent. Dysphagia. 2008;23(4):411–2.CrossRefPubMedGoogle Scholar
  25. 25.
    Tiwari J, Lahoti B, Dubey K, Mishra P, Verma S. Tracheo-oesophageal fistula—an unusual complication following Celphos poisoning. Indian J Surg. 2003;65:442–4.Google Scholar
  26. 26.
    Darbari A, Kumar A, Chandra G, Tandon S. Tracheo-oesophageal fistula with oesophageal stricture due to aluminium phosphide (Celphos Tablet) poisoning. Indian J Chest Dis Allied Sci. 2007;49:241–2.Google Scholar
  27. 27.
    Chugh SN, Ram S, Chugh K, Malhotra KC. Spot diagnosis of aluminium phosphide ingestion: an application of a simple test. J Assoc Physicians India. 1989;37(3):219–20.PubMedGoogle Scholar
  28. 28.
    Mital HS, Mehrotra TN, Dwivedi KK, Gera M. A study of aluminium phosphide poisoning with special reference to its spot diagnosis by silver nitrate test. J Assoc Physicians India. 1992;40(7):473–4.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Rajendra K. Jain
    • 1
  • Narendra B. Gouda
    • 2
  • Virendra K. Sharma
    • 2
  • Tribhuvan N. Dubey
    • 2
  • Atul Shende
    • 3
  • Rajesh Malik
    • 4
  • Gurudutt Tiwari
    • 5
  1. 1.Gastroenterology Division, Department of MedicineGandhi Medical CollegeBhopalIndia
  2. 2.Department of MedicineGandhi Medical CollegeBhopalIndia
  3. 3.Department of MedicineMGM CollegeIndoreIndia
  4. 4.Department of RadiodiagnosisGandhi Medical CollegeBhopalIndia
  5. 5.Taj MarketBhopalIndia

Personalised recommendations