title: Intraperitoneal elemental mercury exposure from a mercury-weighted bougie.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The George Washington University, Washington, DC, USA, maryannmazer@gmail.com.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.forename: Margit L
authors.initials: ML
authors.lastname: Bleecker
authors.forename: Fermin
authors.initials: F
authors.lastname: Barrueto
mesh_terms: D000388:Air / Q000032:analysis; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation*; D004868:Equipment Failure; D015390:Gastric Bypass / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D008297:Male; D019300:Medical Errors / Q000009:adverse effects* / Q000517:prevention & control; D008628:Mercury / Q000032:analysis / Q000097:blood / Q000652:urine; D008630:Mercury Poisoning / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging / Q000601:surgery; D011507:Proteinuria / Q000139:chemically induced; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008628:Mercury