Corrosive gastric injury after formalin ingestion without esophageal impairment: Endoscopic characteristics

Conclusions: The ingestion of pH-neutral formalin has been described only very rarely, may cause severe local, corrosive gastrointestinal injury and/or systemic toxicity.

Patients and methods: A 31-year-old man drank 100ml of formalin after 1 litre of wine in a suicidal attempt. Because of the severe pains in his pharynx, gullet and stomach, and the repeated vomiting, he was admitted to hospital within 30 minutes.

Results: Emergency oesophagogastroduodenoscopy revealed a black mucosa on the posterior wall and a necrotic, erosive, friable mucosa on the anterior wall of the gastric body. The mucosa of the gastric body was oedematous, thickened and rigid, and the gapform lumen distended only minimally on air inflation. Most of the antral mucosa was also black, but the changes were more superficial; the mucosa was not so rigid, the lumen of the antrum distended during air inflation and peristalsis was observed in the antrum. The oesophagus, pylorus, and duodenum were intact. Six days later, greyish-yellow confluent spots were observed on the distal two-thirds of the gastric body and the proximal two-thirds of the antrum. The oedema and the rigidity had decreased.

Two weeks later, a few whitish spots and initial scarring were seen on greater curvature of the antrum. After four weeks the proximal two-thirds of the antrum was partly contracted, and fingertip-like, pseudodiverticular hollows were observed on the greater curvature of the antrum, between scarring wrinkles.

Conclusions: After formalin ingestion, therefore, the severely injured stomach healed with antral scarring and pseudodivertilum formation, without oesophageal involvement and without disturbance of the gastric emptying.