Portal gas embolism after bleach ingestion: the role of hyperbaric oxygen therapy: a case report

Background: Hydrogen peroxide (H2O2) is a widely used chemical compound with disinfectant, oxidizing, and bleaching properties. Ingestion of H2O2 can lead to serious consequences, including mucosal damage, gangrene of the colon, fulminant colitis, and gas embolism. In the gastrointestinal tract, if H2O2 interacts with catalase, oxygen bubbles are released and can enter the blood, leading to severe complications such as portal gas embolism, a rare but potentially life-threatening condition. Case Description: We report a case of portal gas embolism due to the ingestion of a significant amount of a bleach formulation containing 10% H2O2 by a 29-year-old female patient. The patient complained abdominal pain, dyspnea, nausea, and vomiting. Upon admission, clinical and imaging examinations confirmed the diagnosis of intrahepatic gas emboli. So, the patient was treated with hyperbaric oxygen (HBO2) therapy following the U.S. Navy Treatment Table 5 protocol with complete resolution of symptoms after two HBO2 therapy sessions. Follow-up imaging confirmed the absence of intrahepatic gas, and the patient was discharged without any functional impairments. Conclusions: This clinical case underscores the potential effectiveness of HBO2 therapy in treating portal gas embolism caused by H2O2 ingestion. However, due to the limited number of studies available, further research needs to define the appropriate HBO2 treatment protocol for such cases. Early recognition and treatment are crucial in these cases to prevent severe complications and ensure rapid and complete recovery.