Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  4. Moghadamnia AA, Abdollahi M. An epidemiological study of poisoning in northern Islamic Republic of Iran. East Mediterr Health J. 2002;8:88–94.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  6. Bogle RG, Theron P, Brooks P, Dargan PI, Redhead J. Aluminium phosphide poisoning. Emerg Med J. 2006;23(1):e3.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  9. Singh RB, Rastogi SS, Singh DS. Cardiovascular manifestations of aluminium phosphide intoxication. J Assoc Physicians India. 1989;37(9):590–2.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  11. Chittora MD, Meena SR, Gupta DK, Bhargava S. Acute hepatic failure in aluminium phosphide poisoning. J Assoc Physicians India. 1994;42(11):924.

    CAS  PubMed  Google Scholar 

  12. Chhina RS, Thukral R, Chawla LS. Aluminum phosphide-induced gastroduodenitis. Gastrointest Endosc. 1992;38(5):635–6.

    Article  CAS  PubMed  Google Scholar 

  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. Chugh SN, Arora V, Kaur S, Sood AK. Toxicity of exposed aluminium phosphide. J Assoc Physicians India. 1993;41(9):569–70.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  16. Khosla SN, Nand N, Kumar P, Trehan V. Muscle involvement in aluminium phosphide poisoning. J Assoc Physicians India. 1988;36(4):289–90.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  20. Talukdar R, Singal DK, Tandon RK. Aluminium phosphide-induced esophageal stricture. Indian J Gastroenterol. 2006;25(2):98–9.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  24. Somani SK. Aluminium phosphide-induced esophageal stricture palliation with polyflex stent. Dysphagia. 2008;23(4):411–2.

    Article  PubMed  Google Scholar 

  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. 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. 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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Division, Department of Medicine, Gandhi Medical College, E-5/193 B-2 Arera Colony, Bhopal, 462016, Madhya Pradesh, India

    Rajendra K. Jain

  2. Department of Medicine, Gandhi Medical College, Bhopal, 462001, Madhya Pradesh, India

    Narendra B. Gouda, Virendra K. Sharma & Tribhuvan N. Dubey

  3. Department of Medicine, MGM College, Indore, Madhya Pradesh, India

    Atul Shende

  4. Department of Radiodiagnosis, Gandhi Medical College, Bhopal, 462001, Madhya Pradesh, India

    Rajesh Malik

  5. Taj Market, Sultania Road, Bhopal, 462001, Madhya Pradesh, India

    Gurudutt Tiwari

Authors
  1. Rajendra K. Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Narendra B. Gouda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Virendra K. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tribhuvan N. Dubey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atul Shende
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rajesh Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gurudutt Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajendra K. Jain.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jain, R.K., Gouda, N.B., Sharma, V.K. et al. Esophageal Complications Following Aluminium Phosphide Ingestion: An Emerging Issue Among Survivors of Poisoning. Dysphagia 25, 271–276 (2010). https://doi.org/10.1007/s00455-009-9251-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-009-9251-y

Keywords

Search

Navigation