Aluminium phosphide poisoning with esophageal stricture and tracheoesophageal fistula

Background: Aluminium phosphide tablets popularly known, as 'celphos' is a highly toxic fumigant used as insecticide for preservation of food grains. India is an agricultural country and celphos tablets are easily available to psychologically vulnerable young people. It is swallowed with suicidal intent and death comes in minutes. Patients and methods: In this series there were seven patients with tracheo esophageal complications out of 342 patients reviewed. Four patients had esophageal stricture and three had stricture plus tracheo esophageal fistulas. Types of symptoms including progressive dyshagia and extent of respiratory symptoms were evaluated. Nutrition status and success or failure of dilatation at the time of endoscopy was taken into account. The criteria for oesophageal replacement was failed dilatation and complications. They were treated with supportive treatment, antegrade esophageal dilatation, gastric bypass and colon bypass. This was a descriptive interventional study. Results: One of the two patients died before any definitive procedure could be done. Survivors were followed up for 7 months to 4 years. They were evaluated by Quantitative and Qualitative measure instrument (QQMI). QQMI showed the final out come as 'good' in one patient and 'very good', in four patients. Conclusions: Due to their psychological state, inability to swallow oral medicines, critical nature of illness these patients needed intensive individualized therapy to obtain a good outcome. © 2010 Indian Association of Cardiovascular-Thoracic Surgeons.