Answer: Hydrogen peroxide ingestion causing significant portal venous gas and stomach wall thickening
Upon further questioning, it was found that the patient accidentally ingested approximately 50 mL of concentrated 35% hydrogen peroxide (H2O2) solution, which he was using in diluted form as a naturopathic treatment for his diabetes mellitus. He was admitted to our institution and closely monitored for evidence of perforation and respiratory distress. Given the extent of portal venous gas, he was promptly treated with hyperbaric oxygen to prevent cerebral gas embolism. Clinically, he remained stable over the next 24 hours and repeat imaging the next day revealed dramatic improvement of the portal venous gas (Figure C). He was discharged on day 4 of hospitalization with no obvious clinical sequelae. Outpatient gastroscopy was arranged to assess any further potential damage, but he was lost to follow-up.
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