Hemorrhagic panesophagitis after acute organophosphorus poisoning

Organophosphorus insecticides are life-threatening if ingested accidentally or for the purpose of committing suicide. Irreversible inhibition of acetylcholinesterase by these chemicals causes accumulation of acetylcholine, which produces muscarinic, nicotinic, and central nervous system effects.1 If nervous system complications are conspicuous, esophageal lesions may be overlooked. No reports to date have described the endoscopic features of organophosphorus-induced esophagitis, although the features of esophagitis caused by acids and alkalis have been well documented.2-4 Herein, we present a case of acute hemorrhagic panesophagitis after organophosphorus poisoning and describe the endoscopic features differentiating caustic injury to the esophagus from peptic esophagitis as a result of gastroesophageal reflux.