Bowel perforation secondary to local tissue injury from intentional iron overdose

We report the case of a 16-year-old who presented after intentional ingestion of elemental iron (approximately 48 mg/kg). Iron levels at presentation were 4388 mcg/dl. The patient demonstrated symptoms of severe toxicity including hypotension, metabolic acidosis, and multiple organ failure. Fourteen days after ingestion, the patient suffered multiple punctate bowel perforations that were not related to ischemia and appeared to have been the result of local tissue injury from ingested iron. The bowel was successfully primarily repaired. However, the patient eventually succumbed due to the severity of multisystem organ failure and a systemic fungal infection. We report this case to highlight the risk of local tissue trauma from ingested iron, resulting in bowel perforation. This case highlights the need to eliminate ingested iron to limit systemic absorption and to prevent local tissue trauma and bowel perforation.