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Landen S, Wu MH, Jeng LB, Delugeau V, Launois B. Pancreaticoduodenal Necrosis Due to Caustic Burns. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Landen
- Department of Surgery, St. Elisabeth Hospital, Brussels, Belgium
| | - M. H. Wu
- Department of Chest Surgery, National Cheng Kung Hospital, Tainan, Taiwan
| | - L. B. Jeng
- Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - V. Delugeau
- Department of Surgery, St. Elisabeth Hospital, Brussels, Belgium
| | - B. Launois
- Clinique Chirurgicale, Centre Hospitalier Regional, Rennes, France
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Methasate A, Lohsiriwat V. Role of endoscopy in caustic injury of the esophagus. World J Gastrointest Endosc 2018; 10:274-282. [PMID: 30364838 PMCID: PMC6198306 DOI: 10.4253/wjge.v10.i10.274] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023] Open
Abstract
Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Although the caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.
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Affiliation(s)
- Asada Methasate
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Rajabi MT, Maddah G, Bagheri R, Mehrabi M, Shabahang H, Lorestani F. Corrosive injury of the upper gastrointestinal tract: review of surgical management and outcome in 14 adult cases. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2015; 27:15-21. [PMID: 25745607 PMCID: PMC4344970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/15/2014] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion. MATERIALS AND METHODS Between Nov1993 to march 2011, 14 adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals). Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery. RESULTS 14 patients (10men and 4 women) with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in 2 survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient. CONCLUSION Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.
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Affiliation(s)
- Mohammad Taghi Rajabi
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Corresponding Author: Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
| | - Ghodratollah Maddah
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Reza Bagheri
- Cardio- Thoracic Surgery & Transplant Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mostafa Mehrabi
- Surgical Oncology Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hossein Shabahang
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Farjad Lorestani
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Dalus D, Mathew AJ, Somarajan Pillai S. Formic Acid Poisoning in a Tertiary Care Center in South India: A 2-Year Retrospective Analysis of Clinical Profile and Predictors of Mortality. J Emerg Med 2013; 44:373-80. [DOI: 10.1016/j.jemermed.2012.02.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 10/24/2011] [Accepted: 02/19/2012] [Indexed: 01/21/2023]
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Ananthakrishnan N, Parthasarathy G, Kate V. Acute corrosive injuries of the stomach: a single unit experience of thirty years. ISRN GASTROENTEROLOGY 2010; 2011:914013. [PMID: 21991535 PMCID: PMC3168572 DOI: 10.5402/2011/914013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 10/21/2010] [Indexed: 12/17/2022]
Abstract
Introduction. The spectrum of gastric injury due to corrosives can vary. This paper presents a single center experience of over 30 years of corrosive gastric injuries of 39 patients with acute gastric injuries from 1977 till 2006. Patients and Methods. Two thirds of the patients in the acute injury group had a concomitant esophageal injury. The age of the patients ranged from 4 years to 65 years with a slight preponderance of males. (M : F ratio 22 : 17). Results. 36 out of 39 acute gastric injuries were due to ingestion of acids. Three patients had history of caustic soda ingestion. Oral hyperemia or ulcers of varying extent were seen in all patients. The stomach showed hyperemia in 10, extensive ulcers in 13, and mucosal necrosis in 10 patients. Fifteen patients (15/39, 38.5%) were managed conservatively. Twenty four patients (24/39, 61.5%) underwent laparotomy: one for frank peritonitis, 10 for gastric mucosal necrosis, and 13 others for extensive gastric ulcerations. Overall the mortality rate was 29.6 %. Conclusion. Although the mortality and morbidity of acute corrosive gastric injuries is high, the key to improve the survival is early identification of perforation, maintenance of nutrition and control of sepsis.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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Ananthakrishnan N, Parthasarathy G, Kate V. Chronic corrosive injuries of the stomach-a single unit experience of 109 patients over thirty years. World J Surg 2010; 34:758-64. [PMID: 20098987 DOI: 10.1007/s00268-010-0393-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Corrosive gastric injuries are not uncommon in developing countries because acids, which are more frequently associated with gastric injury, constitute the major type of offending chemical. The spectrum of gastric injury may vary from acute to varying types of chronic gastric involvement. METHODS The 109 consecutive patients with chronic corrosive gastric injuries treated in a single tertiary care superspecialty institute over a period of 30 years were reviewed with special reference to presentation and problems in management. RESULTS Acids contributed to 82.6% of chronic injuries. Chronic gastric injuries were usually one of five types in these patients. The majority had prepyloric strictures (83.5%). The remaining strictures were antral (4.6%), body (3.7%), pyloroduodenal (2.7%), or diffuse (5.5%).Twenty-one (22.8%) patients had a delayed gastric outlet obstruction, and18 patients had a concomitant esophageal stricture requiring a bypass. Most of the patients with chronic injury underwent surgical correction with Billroth I gastrectomy (77.1%), loop gastrojejunostomy (11.0%), and distal gastrectomy with Polya reconstruction (3.7%). Other procedures performed were pyloroplasty in 1 patient and colonic conduit jejunal anastomosis in 6 patients. One patient (1%) died in the postoperative period. CONCLUSIONS The management of chronic corrosive gastric injury depends on the type of gastric involvement, the presence of co-existent esophageal stricture, and the general condition of the patient. A limited resection of the affected stomach is the ideal procedure for the common type of gastric injury. In patients whose general condition prohibits major resection or where the stricture extends to the antrum the best treatment is a loop gastroenterostomy. Type III, IV, V strictures require individualized treatment. Delayed gastric outlet obstruction affects the treatment plan of combined gastric and esophageal injuries.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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Kochhar R, Poornachandra KS, Dutta U, Agrawal A, Singh K. Early endoscopic balloon dilation in caustic-induced gastric injury. Gastrointest Endosc 2010; 71:737-44. [PMID: 20363415 DOI: 10.1016/j.gie.2009.11.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 11/19/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are no reports on endoscopic balloon dilation (EBD) for caustic-induced gastric outlet obstruction (GOO) in the acute or subacute phase. OBJECTIVE To study the efficacy of early EBD in patients with caustic-induced gastric injury. SETTING Tertiary care center in India. DESIGN Retrospective analysis of data. PATIENTS Out of 41 patients with caustic-induced GOO who reported to us in the subacute phase between January 2001 and December 2008, 31 were treated by EBD. All 31 had ingested an acid 14.39 +/- 4.65 days earlier. EBD was achieved by using wire-guided balloons under endoscopic guidance. INTERVENTION The balloon was negotiated across the narrowed segment and inflated for 60 seconds using a pressure gun. Balloons of incremental diameter, up to a maximum of 3 sizes, were used in each sitting. Procedural success was defined as reaching the end point of dilation (15 mm) and absence of symptoms. RESULTS All 31 patients (18 male, mean age 32.06 +/- 11.04 years) could be successfully dilated. All but 1 underwent successful dilations to achieve the end point of 15 mm, requiring a median of 9 (range 3-18) dilations over a period of 7 (range 1.5-16) weeks. Complications included self-limiting pain (n = 10), bleeding at the time of the procedure (n = 9), and perforation in 1 patient (3.2%) who required surgery. Thirty patients were followed up for a median of 21 (range 3-72) months with no recurrence. CONCLUSION Early EBD by an expert endoscopist is a safe and effective treatment modality in the management of caustic-induced GOO.
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Affiliation(s)
- Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Kar H, Batuk G, Cekin N, Isler HB, Uzun I, Arslan MM. Deaths due to corrosive ingestion: a 10-year retrospective study. Toxicol Mech Methods 2006; 16:405-9. [PMID: 20021014 DOI: 10.1080/15376510600860490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Evaluation of the substances used, macroscopic and microscopic autopsy findings, and the manner of corrosive ingestion deaths in Istanbul are aimed in this study. METHODS The autopsy records of the corrosive ingestion cases in Istanbul, Turkey, between 1992 and 2001 are investigated in our retrospective descriptive study. RESULTS The cause of death was determined as "corrosive injury" in 23 (0.089%) cases among 25,763 autopsy cases. Among these cases one was in the child age group and the corrosive substance ingestion was accidental, whereas all the other cases were adults and the ingestion was for suicidal intent. Sixteen (69.6%) of the cases were female. Nitric acid was the most frequent agent with 13 cases (56.5%). Necrosis of esophagus was determined in 19 cases (82.6%) and perforation of stomach in 11 cases (47.8%). CONCLUSION Guidance and education are important tools for prevention from corrosive injuries, but we believe that the best weapon is to restrict easy access to corrosive agents by prohibiting the free commercialization of these most potent agents.
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Affiliation(s)
- Hakan Kar
- Specialist in Forensic Medicine, Council of Forensic Medicine, Adana Group Administration, Adana, Turkey
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Abstract
Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. In this paper, we review demographic features and endoscopic results of the patients admitted to a university emergency department with a history of caustic substance ingestion between January 2000 and June 2003. Thirty-seven patients were included in this study. Twenty-one of the patients were female and 16 were male. The mean age of the patients was 30.9 +/- 14.7 years. The agents included sodium hypochlorite in 24 patients and hydrochloric acid in 13 patients. All the patients ingested these agents orally. The mean interval time of admission to emergency department after ingestion of caustic agent was 5.4 +/- 5.6 hours. Endoscopy was attempted in 37 patients. Endoscopic results were as follows: grade 0 in 8 (21.6%) patients, grade 1 in 17 (45.9%) patients, grade 2a in 5 (13.5%) patients, and grade 2b in 7 (18.9%) patients. We believe that early signs and symptoms after caustic substance ingestion are not consistent with the extent of damage, and endoscopy is the only reliable method to assess injury. It is important that efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.
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Affiliation(s)
- Salim Satar
- Emergency Department, Faculty of Medicine, Cukurova University, 01330 Yuregir, Adana, Turkey.
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Abstract
Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral stenosis and the development of esophageal carcinoma. Endoscopy should be attempted and can be safely performed in most cases to assess the extent of damage. Procedure-related perforation is rare. Stricture formation is more common in patients with second and third degree burns. Corticosteroids may help prevent stricture formation. Esophageal carcinoma may develop beginning 30 to 40 years after the time of injury.
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Affiliation(s)
- Kovil Ramasamy
- The Department of Medicine, Mount Sinai Services, City Hospital Center at Elmhurst, New York, New York, USA
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Abstract
Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.
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Affiliation(s)
- Feryal Gün
- Istanbul University, Istanbul Medical School, Department of Pediatric Surgery, Turkey.
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Wharton RH, Wang T, Graeme-Cook F, Briggs S, Cole RE. Acute idiopathic gastric dilation with gastric necrosis in individuals with Prader-Willi syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1997; 73:437-41. [PMID: 9415471 DOI: 10.1002/(sici)1096-8628(19971231)73:4<437::aid-ajmg12>3.0.co;2-s] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Individuals with Prader-Willi syndrome (PWS) have excessive appetite with the ability to consume large quantities of food. Absence of vomiting and a high pain threshold are considered manifestations of the disorder. We present 6 patients with PWS with acute dramatic gastric distention. In 3 young adult women with vomiting and apparent gastroenteritis, clinical course progressed rapidly to massive gastric dilatation with subsequent gastric necrosis. One individual died of overwhelming sepsis and disseminated intravascular coagulation. In 2 children, gastric dilatation resolved spontaneously. Gastrectomy specimens--in 2 cases subtotal and distal, in the other with accompanying partial duodenectomy and pancreatectomy--showed similar changes. All cases demonstrated signs of ischaemic gastroenteritis. All specimens showed diffuse mucosal infarction with multifocal transmural necrosis. Vascular dilatation and small bifrin thrombi were apparent within the infarcted areas. These 6 women with PWS had acute idiopathic gastric dilatation. It is possible that a predisposition to acute gastric dilatation may be related to abnormal gastric homeostasis on a genetic basis. Understanding the mechanisms responsible for this event could increase the understanding of gastrointestinal and appetite regulation in individuals with PWS.
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Affiliation(s)
- R H Wharton
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Abstract
Strong acid ingestion produces distinctly different injuries from alkali burns. Alkali burns are well described but the lack of literature on the diagnosis and management of acid burns is apparent. This retrospective review of 18 patients with battery acid (30% sulphuric acid) ingestion showed no correlation between the severity of the symptomatology and the degree of injury. The quantity of acid needed to cause a significant upper GIT burn was more than 200 ml. Previous reports that acid spared the oesophagus due to rapid transit were disproved, since oesophageal involvement was found in 55% (10/18). Deep burns rather than circumferential burns resulted in stricture formation. The major injury site was the gastric antrum with 4 patients (23%) requiring surgical intervention to restore function.
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Affiliation(s)
- P J Wormald
- Department of Otolaryngology, Groote Schuur Hospital, Cape Town, South Africa
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Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology 1989. [PMID: 2753330 DOI: 10.1016/0016-5085(89)90641-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We have prospectively evaluated 41 patients who ingested acid for location, extent, severity, and outcome of the injury to the upper gastrointestinal tract. The injury was assessed within 36 h of acid intake by endoscopy or surgery, or at autopsy. Symptoms and signs were unreliable in predicting the extent and severity of injury. The degree of burns was classified as follows: grade 0 in 2 patients, grade 1 in 3, grade 2 in 16, and grade 3 in 20. Esophageal injury was seen in 87.8% of the patients, gastric injury in 85.4%, and duodenal injury in 34.1%. All patients with grade 0, 1, and 2a injury recovered without sequelae. Acute complications occurred in 39.1% of the cases, and death in 12.2%. It is significant that all such patients had grade 3 burns. Five of the 8 patients with grade 2b injury and all survivors of grade 3 injury developed esophageal or gastric cicatrization, or both, which subsequently needed endoscopic or surgical treatment. We find that endoscopy is not only the tool of choice for diagnosis in such cases but also aids in deciding upon treatment and prognosis. We conclude that acid injury of the upper gastrointestinal tract is a very serious condition that affects the esophagus and stomach equally and results in high morbidity and mortality.
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Affiliation(s)
- S A Zargar
- Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Pense SC, Wood WJ, Stempel TK, Zwemer FL, Wachtel TL. Tracheoesophageal fistula secondary to muriatic acid ingestion. Burns 1988; 14:35-8. [PMID: 3370514 DOI: 10.1016/s0305-4179(98)90039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acid ingestion may result in a variety of early and late complications. A patient is presented with severe sequelae from muriatic acid ingestion, including a tracheoesophageal fistula which is a previously unreported complication of acid ingestion injury. Recommendations are made for diagnosis and prevention of this potentially lethal complication.
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Affiliation(s)
- S C Pense
- Phoenix Integrated Surgical Residency
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Gossot D, Sarfati E, Celerier M. Early blunt esophagectomy in severe caustic burns of the upper digestive tract. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36280-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
While alkali ingestion nearly always injures the esophagus, acid usually spares the esophagus and damages the gastric outlet. Most reported cases of acid gastric injury have required resection. We report a case of acid ingestion managed with parenteral nutrition and histamine blockers in which healing is documented without operation.
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Estrera A, Taylor W, Mills LJ, Platt MR. Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach. Ann Thorac Surg 1986; 41:276-83. [PMID: 3954499 DOI: 10.1016/s0003-4975(10)62769-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
During a six-year period ending in December, 1980, 62 patients with a history or clinical evidence of corrosive ingestion were admitted into our institutions. The majority were adults who had attempted suicide. Strong alkali (lye), the most common corrosive agent involved, was ingested by more than half of the patients (39). The remaining 23 patients had ingested weak alkali or nonalkali corrosive agents. Of the 27 patients with severe esophagogastric burns (second- and third-degree), a 43.5% incidence overall, liquid lye was responsible in 21, including 7 of 8 patients with extensive full-thickness esophagogastric necrosis. In sharp contrast, only 1 of the 23 patients who had ingested weak alkali or nonalkali corrosive agents had serious esophagogastric injury. In the first two years of this review, the management approach was the so-called standard one (esophagoscopy, steroids, antibiotics, and dilation) (Group 1). The results were disappointing. In 5 of 9 patients with endoscopic findings of second-degree burns, stricture requiring dilation developed, and all 4 with extensive full-thickness esophagogastric necrosis died. In contrast, during the last four years, with the adoption of a more aggressive surgical approach, that is, early surgical intervention including the use of an intraluminal esophageal stent and radical resection as indicated, missed or delayed diagnosis of full-thickness esophagogastric necrosis with its prohibitive mortality was avoided and the complication of severe esophageal stricture was virtually eliminated (Group 2).(ABSTRACT TRUNCATED AT 250 WORDS)
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Soni N, O'Rourke I, Pearson I. Ingestion of hydrochloric acid. Med J Aust 1985; 142:471-2. [PMID: 3982354 DOI: 10.5694/j.1326-5377.1985.tb113459.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case of intentional ingestion of concentrated acid, in which both disseminated intravascular coagulation and acute respiratory insufficiency complicated initial resuscitation, is reported. The assessment and the acute management of this unusual problem are reviewed, with emphasis on early endoscopy and laparotomy.
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Abstract
Sixteen patients with corrosive acid ingestion were studied. The majority of patients (n = 10) had ingested sulphuric acid, and three other patients had ingested hydrochloric acid. The extent and severity of upper gastrointestinal tract injury was determined by fibreoptic endoscopy and necropsy. All the patients had oesophageal and gastric involvement but the duodenum was spared in the majority. The injury was not considered as mild (grade I) in any of these patients; five patients having moderate (grade II) and 10 patients having severe (grade III) injury. Complications and mortality occurred only in patients with grade III injury. Feeding jejunostomy for nutritional support was used in five patients (all grade III) with good results.
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Abstract
A 27-year old female received about 1 kg of salt in about 600 ml of water as an emetic after a self-poisoning attempt. Vomiting did not occur and massive necrosis of gastric, duodenal, and jejunal mucosa resulted in a severe and prolonged illness which required 31 weeks of continuous hospital care and 31 laparotomies over a period of 16 months. The dangers of salt emesis are emphasized.
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Surgical Approach to Chemical Burn Injuries of the Upper GI-Tract. Arch Toxicol 1982. [DOI: 10.1007/978-3-642-68511-8_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
Acid corrosive gastritis is infrequently seen. It spares the esophagus and damages the antrum. It causes mucosal ulceration, damages the muscularis and ends in a typical antral stricture. The dynamic perpetuating pathophysiologic events, starting with coagulation necrosis, impose postponement of surgical intervention. Two cases of second degree acid corrosive gastritis are presented. Surgery was performed in both patients, only after dysphagia and vomiting became intractable.
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Abstract
The effects of strong acid ingestion are distinctly different from those of alkali. Strong acids produce superficial injuries to the esophagus and deep injuries to various portions of the stomach. Prevailing early treatment recommendations of simple dilution or weak-base neutralization are inappropriate because of their extraordinary thermal results. Dilution of concentrated sulfuric acid with an equivalent volume of water results in a temperature elevation of approximately 80 C. Neutralization results in even greater heat production. Vigorous gastric aspiration prior to cold fluid lavage is the management of choice in cases treated immediately following acid ingestion.
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Claudel S, Moulinier B, Martin A, Lambert R, Ducluzeau R. Surveillance endoscopique des lésions muqueuses digestives après ingestion de caustiques. ACTA ACUST UNITED AC 1980. [DOI: 10.1007/bf02970974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lowe JE, Graham DY, Boisaubin EV, Lanza FL. Corrosive injury to the stomach: the natural history and role of fiberoptic endoscopy. Am J Surg 1979; 137:803-6. [PMID: 453476 DOI: 10.1016/0002-9610(79)90099-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most physicians recognize that the ingestion of lye is associated with severe esophageal damage. It is much less widely known that gastric injury is the predominant finding when acid is ingested. We are reporting on five patients who had severe gastric damage after ingestion of diluted sulfuric acid (three cases), capsules of potassium hydroxide, and Clinitest tablets (one case each). Fiberoptic endoscopy was used to localize the extent and severity of injury and to follow the evolution of the damage. The extent and location of injury varied with the amount and type of agent ingested. Acid ingestion resulted in severe gastritis, which eventually led to antral stenosis and gastric outlet obstruction requiring operative intervention in two cases. Potassium hydroxide capsules produced diffuse esophagitis, gastritis, and a non-healing large gastric ulcer. Clinitest tablets produced distal esophagitis and stricture and antral damage leading to gastric outlet obstruction which required operative intervention. These cases demonstrate the natural history of corrosive injury to the stomach and the value of fiberoptic endoscopy in the management of this problem.
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Abstract
Because it causes immediate pain when taken into the mouth, strong mineral acid is less often swallowed than corrosive alkali, but psychotic, inebriated or determined individuals may consume lethal amounts. Burns of the oropharynx and glottis may lead to asphyxial death. Acid has only superficial effects upon the esophagus but, upon reaching the stomach, flows along the lesser curvature, induces pylorospasm, and pools in the distal antrum. Pyloric stricture is the most common late complication among survivors. Due to the rapidity with which acid acts, local and systemic therapy must be expeditious. Neutralization and demulcification are recommended but no time should be lost if weak alkali is not readily available. Lavage has limited applicability and induced emesis is strictly contraindicated. Aggressive intravenous fluid therapy, antibiotics, and opiates for pain are needed in most instances. Immediate gastrectomy and steroids are controversial but operative intervention is eventually required following most significant ingestions.
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