Introduction: Acute intoxication rarely produces conditions that require urgent surgical care.
Case summary: A 45-year-old man presented to the emergency department with severe abdominal pain after the deliberate ingestion of 200 cm3 of polyurethane mixed with methylene diphenyl diisocyanate and urethane primers. On an initial laparoscopic examination, foreign material was observed in the peritoneal space with haemoperitoneum. Emergency exploration was then undertaken for suspected gastric perforation. Full-thickness damage was identified on the stomach wall during the operation. The material in the gastrointestinal tract and peritoneal space was gently removed. Moulded casts of the entire stomach and distal oesophagus were extracted successfully. The patient was discharged 14 days after surgery.
Images: Computed tomography revealed foreign material occupying the entire gastric chamber, as well as diffuse gastric perforation.
Conclusions: Life-threatening gastric perforation can occur after polyurethane foam ingestion. Clinical/medical toxicologists and emergency physicians need to be aware of the highly expandable nature of this agent.
Keywords: Polyurethane foam; acute care surgery; blast injury; gastric perforation; suicide attempt.