Stomach perforation from piroxicam poisoning

Abstract

An 8-year-old girl presented with stomach perforation one week after piroxicam poisoning. Six hours before hospitalization, the girl had accidentally taken piroxicam capsules in a total dose of 280 mg. At admission the child did not present signs and symptoms of intoxication of piroxicam. In spite of the late time of presentation from piroxicam exposure, we performed gastric lavage, and administered activated charcoal and laxatives. The patient was discharged after 24 hours, in good clinical condition, but without gastro protective medication. After a period of seven days the patient was readmitted to the PICU, with signs and symptoms of acute abdomen: severe epigastric pain whose intensity increased with the change of position, nausea, vomiting, fever and chills. On physical examination, abdominal rigidity of the muscles was noticed. On the abdominal X-ray free air in the abdomen was visualized. The child underwent emergency surgery. Stomach perforation was identified and corrected. Ten days after the surgery, the child was discharged, fully recovered.

Conclusion - We present this rare case to alert physicians to the necessity of monitoring abdominal signs and symptoms and consideration of use of gastro protective agents after piroxicam overdose in a child.