부산대학교 도서관

Objective: The optimum treatment of omphalocele is immediate surgical repair. When this cannot be accomplished, the non-operative treatment of major omphalocele includes such techniques as painting the defect with mercurochrome, chlorhexidine, silver nitrate, povidine iodine, gentian violet or isopropyl alcohol. None of these methods has been proven ideal because of significant toxicity. Mercurochrome, in particular, has been noted to cause mercury toxicity and death in the neonatal patient. Its use had been abandoned in most centers due to significant toxicity. We present a case of significant mercury toxicity due to the use of mercurochrome and the difficulties in diagnosis as well as treatment of this neonate. Case Report: The patient is a female born at weight of 2.875 kg via elective c-section due to omphalocele. Initial measurements of the defect were 9 x 9 cm with the whole liver and most of the intestines contained in the sac. No other birth defects were noted. Primary surgical closure was unsuccessfully attempted and non-operative approach using a one time painting of the defect with 5% mercurochrome was employed. Approximately 16 hours after the mercurochrome use, the plasma mercury level was 1017 mcg/L. The toxicologist was consulted several days later when the patient became difficult to console and tremulous. Chelation, using DMSA, was started immediately (Day #0). Successive levels measured were 177 mcg/L (Day #1), 155 mcg/L (Day #5), Pending (Day #12). Conclusion: Omphaloceles are difficult to treat conservatively due to the toxicity of the agents used. The toxicity may be easily missed especially in the neonate. Therefore the clinician must have a high index of suspicion when these agents are used.
Cullen N, Bruzzzini D, Henretig F. Wright State University, Dayton, Ohio; PPC, Philadelphia, Pennsylvania, [...]