Gross and Histopathological Changes in Gastrointestinal Tract in Cases of Acute Transoral Paraquat Poisoning

Abstract

Abstract Background and Justification Paraquat is one of the easily available household poisons and has become an easy source of committing suicide, especially in rural India including in West Bengal where it is used as a “weedkiller.” Out of the fatal 272 poisoning cases where autopsies were done at NRSMCH Morgue in the year 2019, 56.6% of cases died due to transoral paraquat poisoning. Though adequate literature is available showing gross and microscopic changes in lungs, liver, and kidneys following transoral paraquat poisoning, data showing the effect of the poison in the gastrointestinal (GI) tract is limited though its detrimental effects on the GI tract are associated with increased morbidity. Objectives The objectives of the study were to assess the gross and histopathological changes in different parts of the GI Tract involving lips, tongue, esophagus, and stomach in paraquat death cases brought for autopsy in NRSMCH Morgue, Kolkata, to fill the gap in the existing literature to a certain extent. Methods The study was a descriptive, cross-sectional study that was done over 5 months and during which we got 38 cases based on inclusion and exclusion criteria. Results Macroscopically Congestion with erosion and hemorrhage was seen mostly in the stomach followed by the esophagus. Histopathologically desquamation was the consistent finding in all organs attributed to the corrosive property of the paraquat solution. Chronic inflammatory cell infiltrations are predominantly seen in the tongue followed by the esophagus and lips. Hyperplasia of the surface epithelium was noticeable mostly in the esophagus followed by the tongue and lips but not in the stomach. Involvement of Distortion of glandular architecture in the stomach outnumbers the other organs, followed by the tongue. Necrotic changes were limited to the stomach and esophagus only. Both ulceration and necrotic changes were predominantly limited to the lowermost part of the esophagus than its rest portion, mainly at the junction of the esophagus and stomach where the surface epithelium shifted from squamous to columnar variety. Conclusion The result of the study can be utilized by healthcare professionals to prepare proper medical/surgical interventions to reduce mortality and morbidity in transoral paraquat poisoning cases concerning GI complications.