275 Gastrointestinal Catastrophe After Ingestion of Liquid Nitrogen-Treated Candy: A Case of Dragon’s Breath-Induced Perforation and Postoperative Complications

Abstract Clinical Case Summary A 14-year-old boy presented to the Emergency Department of Mayo Hospital, Lahore, Pakistan, two hours after consuming "Dragon’s Breath" candy—a snack infused with liquid nitrogen. He complained of severe abdominal pain and distension. On examination, he was tachycardic and had a tense, tender abdomen with signs of generalized peritonitis. An abdominal X-ray revealed massive pneumoperitoneum. A provisional diagnosis of hollow viscus perforation was made. Emergency exploratory laparotomy revealed a large gush of air upon entering the peritoneal cavity and a 3×2 cm perforation along the lesser curvature of the stomach near the incisura angularis. Primary repair was performed using double-layer absorbable sutures, with drain placement in the lesser sac. The patient was shifted to HDU postoperatively. The drain was removed on postoperative day two, and recovery remained uneventful. He was discharged on the sixth postoperative day. Three days later, the patient returned with hematemesis and melena with a hemoglobin level of 8 g/dL with microcytic anemia. He was resuscitated and transfused. Upper GI endoscopy revealed mild erosive gastritis without evidence of active bleeding or perforation. Purpose of the Case This case highlights the dangerous complications associated with ingestion of liquid nitrogen, which is increasingly used in novelty snacks and entertainment. Gastric perforation is a life-threatening emergency requiring prompt surgical intervention. Key Learning Points Liquid nitrogen-infused products pose significant risks, especially to children and adolescents. Strict regulatory safety measures are necessary at national and international levels. Follow-up upper GI endoscopy is recommended to detect and manage delayed complications.