A Rare Case of Hydrogen Peroxide-Induced Gastric Emphysema and Portal Venous Gas Embolism Treated With Hyperbaric Oxygen Therapy

A 52-year-old male accidentally ingested approximately 100 mL of 35% hydrogen peroxide (H2O2), resulting in the sudden onset of gastrointestinal and neurologic symptoms. Non-contrast abdominal CT revealed extensive portal venous gas and gastric pneumatosis. The patient was treated with hyperbaric oxygen therapy which resulted in complete resolution of symptoms. The case highlights the therapeutic value of hyperbaric oxygen therapy in the treatment of vascular gas embolism and mitigation of concentrated H2O2 ingestion toxicity.

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Application of a new hyperbaric oxygen therapy protocol in patients with arterial and venous gas embolism due to hydrogen peroxide poisoning

Undersea and Hyperbaric Medicine ◽

10.22462/03.04.2021.10 ◽

2021 ◽

pp. 187-193

Author(s):

Je-seop Lee ◽

◽

Youn Sung Cha ◽

Keyword(s):

Hydrogen Peroxide ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Gastric Wall ◽

Brain Magnetic Resonance Imaging ◽

Gas Embolism ◽

Venous Gas Embolism ◽

Transient Loss ◽

Therapy Protocol

Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.

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Hyperbaric Oxygen Therapy for Systemic Gas Embolism after Hydrogen Peroxide Ingestion

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.08.091 ◽

2014 ◽

Vol 46 (2) ◽

pp. 171-175 ◽

Cited By ~ 10

Author(s):

Brendan Byrne ◽

Robert Sherwin ◽

Cheryl Courage ◽

Alfred Baylor ◽

Bram Dolcourt ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Gas Embolism

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Treatment of Portal Venous Gas Embolism With Hyperbaric Oxygen After Accidental Ingestion of Hydrogen Peroxide: A Case Report and Review of the Literature

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2009.07.043 ◽

2012 ◽

Vol 43 (1) ◽

pp. e21-e23 ◽

Cited By ~ 11

Author(s):

Sotirios Papafragkou ◽

Anna Gasparyan ◽

Richard Batista ◽

Paul Scott

Keyword(s):

Hydrogen Peroxide ◽

Case Report ◽

Hyperbaric Oxygen ◽

Gas Embolism ◽

Review Of The Literature ◽

Accidental Ingestion ◽

Portal Venous Gas ◽

Venous Gas Embolism

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Hyperbaric oxygen therapy for the prevention of arterial gas embolism in food grade hydrogen peroxide ingestion

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2016.12.027 ◽

2017 ◽

Vol 35 (5) ◽

pp. 809.e5-809.e8 ◽

Cited By ~ 4

Author(s):

Stephen M. Hendriksen ◽

Nicholas L Menth ◽

Bjorn C. Westgard ◽

Jon B. Cole ◽

Joseph W. Walter ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Gas Embolism ◽

Food Grade ◽

Arterial Gas Embolism

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Gas Embolism After Ingestion of Hydrogen Peroxide

PEDIATRICS ◽

10.1542/peds.85.4.593 ◽

1990 ◽

Vol 85 (4) ◽

pp. 593-594

Author(s):

WAYNE R. RACKOFF ◽

DAVID F. MERTON

Keyword(s):

Hydrogen Peroxide ◽

Case Report ◽

Venous System ◽

Hydrogen Peroxide Solution ◽

Portal Venous System ◽

Gas Embolism ◽

Colonic Irrigation ◽

Radiographic Evidence ◽

Portal Venous Gas ◽

Venous Gas Embolism

Gas embolism to the portal venous system is a well-recognized radiographic sign in infants with necrotizing enterocolitis. It also has been seen after colonic irrigation with hydrogen peroxide solution.1,2 We present what we believe is the first reported patient with radiographic evidence of portal venous gas embolism after ingestion of hydrogen peroxide solution. This finding is important because gas embolism to the portal venous system after colonic irrigation with hydrogen peroxide has been associated with gangrenous and perforated bowel.1,2 CASE REPORT A 2-year-old boy ingested an unknown amount of 3% hydrogen peroxide solution. The child was found with foam around his mouth.

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