Lead poisoning: an important differential diagnosis in acute colonic pseudo-obstruction

INTRODUCTION: Lead poisoning remains an important public health concern. We highlight the findings in a patient with a high blood lead concentration. These images can assist clinicians in making the correct diagnosis. CASE SUMMARY: A 44-year-old male presented with a 3-day history of nausea, vomiting, and obstipation. The diagnosis was intestinal obstruction, which failed to respond to conservative management. After exploratory laparotomy and colostomy failed to identify an etiology of acute colonic pseudo-obstruction (Ogilvie syndrome), lead poisoning was diagnosed based on anemia, basophilic stippling of erythrocytes, and a whole-blood lead concentration of 71.87 µg/dL (reference <10.00 µg/dL). The patient recovered with chelation therapy. IMAGES: Abdominal computed tomography (CT) scan revealed copious intraluminal feces and gas within the bowel. Peripheral smear revealed poikilocytosis with basophilic stippling. CONCLUSION: In patients with acute colonic pseudo-obstruction, abdominal pain and anemia, a detailed history is essential, and lead poisoning should be suspected.