A patient with numerous tablets remaining in the stomach even 5 hours after ingestion

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The current consensus suggests that gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and that the procedure can be undertaken within 60 minutes of ingestion. However, it can be difficult to identify those who might potentially benefit from gastric lavage in some cases because some life-threatening drugs such as tricyclic antidepressants tend to remain in the stomach longer. We report a case that necessitated gastric lavage using abdominal computed tomography (CT). An 83-year-old man was taken to our hospital on suspicion of life-threatening acute poisoning with aspiration pneumonia. Chest CT happened to confirm that the patient had a large number of tablets in his stomach. Gastric lavage was performed without intubation, and we observed numerous residual tablets passing through. A total of 6 L was used, and we administered activated charcoal. He recovered without any complications related to this episode. He admitted that he had tried to commit suicide by ingesting approximately a hundred of ursodeoxycholic acid 5 hours before being taken to our hospital. We could decontaminate numerous residual tablets even 5 hours after the ingestion. If there is doubt as to whether or not to use gastric lavage, it is possible to use abdominal CT as a noninvasive method to evaluate the appropriateness of gastric lavage.

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