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Stoica A, Lionte C, Palaghia MM, Gîrleanu I, Şorodoc V, Ceasovschih A, Sîrbu O, Haliga RE, Bologa C, Petriş OR, Nuţu V, Trofin AM, Bălan GG, Catana AN, Coman AE, Constantin M, Puha G, Morăraşu BC, Şorodoc L. Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review. J Pers Med 2023; 13:987. [PMID: 37373976 DOI: 10.3390/jpm13060987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.
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Affiliation(s)
- Alexandra Stoica
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cătălina Lionte
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mădălina Maria Palaghia
- General Surgery Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- First General Surgery Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Irina Gîrleanu
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Gastroenterology Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Victoriţa Şorodoc
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Alexandr Ceasovschih
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Oana Sîrbu
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Cristina Bologa
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ovidiu Rusalim Petriş
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
- Nursing Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Vlad Nuţu
- General Surgery Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- First General Surgery Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ana Maria Trofin
- General Surgery Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second General Surgery Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Gheorghe G Bălan
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Gastroenterology Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Andreea Nicoleta Catana
- Infectious Diseases Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Adorata Elena Coman
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
- Preventive Medicine and Interdisciplinary Team Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Constantin
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Gabriela Puha
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Bianca Codrina Morăraşu
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Laurenţiu Şorodoc
- Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
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Alfaro-Pacheco R, Brenes-Barrantes R, Juantá-Castro J, Rojas-Chaves S, Echeverri-McCandless A, Brenes-Barquero P. First experience with a supercharged pedicled jejunal interposition for esophageal replacement after caustic ingestion in a middle-income Latin American country. Int J Surg Case Rep 2023; 106:108293. [PMID: 37167690 DOI: 10.1016/j.ijscr.2023.108293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
Caustic or corrosive substance ingestion that results in severe esophageal and gastric lacerations frequently requires surgical management. The most common sequelae after an upper gastrointestinal tract caustic injury include non-responding luminal strictures, which are subject to esophageal replacement. Late corrective surgery may include esophagectomy with gastric pull-up and jejunal or colonic interpositions. Although long-segment esophageal reconstruction with jejunum is technically feasible and has demonstrated good outcomes, the complexity of the surgery has precluded the widespread use of this procedure in low- and middle-income countries. This document summarizes the most relevant aspects of caustic ingestion surgical management and describes the first Latin American experience in the reconstruction of an esophageal-gastric caustic injury using a pedicled jejunal interposition, as a viable and functional option in mid- and lower-income countries with well-established Thoracic Surgery departments and microsurgery access.
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Affiliation(s)
- R Alfaro-Pacheco
- Servicio de Cirugía de Tórax, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica.
| | - R Brenes-Barrantes
- Servicio de Cirugía de Tórax, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica
| | - J Juantá-Castro
- Servicio de Cirugía Oncológica y Microcirugía, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica
| | - S Rojas-Chaves
- Unidad de Investigación, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica
| | - A Echeverri-McCandless
- Unidad de Investigación, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica
| | - P Brenes-Barquero
- Servicio de Cirugía de Tórax, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica
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Altuwaijri JK, Hamiduddin FM, Khafaji RH, Almaghrabi LT, Bakhsh HT, Thabit AK. Use of Antibiotics in Poisonous Ingestions of Corrosives and Organophosphates: A Retrospective Cohort Study. TOXICS 2023; 11:300. [PMID: 37112527 PMCID: PMC10142973 DOI: 10.3390/toxics11040300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
The use of antibiotics following oral poisoning by corrosives and organophosphates is controversial. We assessed the clinical outcomes of using antibiotics in acute poisonous ingestion involving corrosives or organophosphates by conducting a retrospective cohort study of patients presenting to the emergency department following ingestion of corrosives or organophosphates who received either antibiotics or supportive care. The endpoints included clinical stability, length of stay (LOS), and mortality. Of 95 patients, 40 received antibiotics and 55 received supportive care. The median age was 2.1 and 2.7 years, respectively (p = 0.053). Bacterial growth was shown in only 2 of 28 cultures (both were respiratory), but with hospital-acquired organisms as it was shown ≥4 days post-admission. Clinical stability rates were 60% and 89.1% in the antibiotic and supportive care groups, respectively (p < 0.001). Median LOS was 3 vs. 0 days (p < 0.001), and no mortality was recorded. NG/G-tube placement was the only factor associated with clinical failure (OR, 20.97; 95% CI, 2.36-186.13). Antibiotic use was not associated with higher chances of clinical stability, which may suggest that their use was unnecessary. Clinicians are encouraged to use antibiotics wisely, and only in the presence of a clear indication of an infection. This study provides a basis for future prospective studies to confirm its findings.
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Affiliation(s)
- Joud K. Altuwaijri
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Fatma M. Hamiduddin
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Raghad H. Khafaji
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Leyan T. Almaghrabi
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Hussain T. Bakhsh
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Abrar K. Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
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Mahmoudvand Z, Shanbehzadeh M, Shafiee M, Kazemi-Arpanahi H. Developing the minimum data set of the corrosive ingestion registry system in Iran. BMC Health Serv Res 2022; 22:1207. [PMID: 36167583 PMCID: PMC9513958 DOI: 10.1186/s12913-022-08576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Corrosive ingestion is still a major health problem, and its outcomes are often unpredicted. The implementation of a registry system for poisoning with corrosive substances may improve the quality of patient care and might be useful to manage this type of poisoning and its complications. Therefore, our study aimed to establish a minimum data set (MDS) for corrosive ingestion. Methods This was an applied study performed in 2022. First, a literature review was conducted to identify the potential data items to be included in the corrosive ingestion MDS. Then, a two-round Delphi survey was performed to attain an agreement among experts regarding the MDS content, and an additional Delphi step was used for confirming the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and by using other statistical tests. Results After the literature review, 285 data items were collected and sent to a two-round Delphi survey in the form of a questionnaire. In total, 75 experts participated in the Delphi stage, CVI, kappa, and CVR calculation. Finally, the MDS of the corrosive ingestion registry system was identified in two administrative and clinical sections with 21 and 152 data items, respectively. Conclusions The development of an MDS, as the first and most important step towards developing the corrosive ingestion registry, can become a standard basis for data collection, reporting, and analysis of corrosive ingestion. We hope this MDS will facilitate epidemiological surveys and assist policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.
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Affiliation(s)
- Zahra Mahmoudvand
- Department of Health Information Technology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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Yu Z, Luong D, Ibraheem C, Townend PJ, Rutherford L, Jeyarajan E. Early oesophageal reconstruction post caustic injury. ANZ J Surg 2021; 92:1902-1904. [PMID: 34783419 DOI: 10.1111/ans.17370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Zirong Yu
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Luong
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Christian Ibraheem
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Philip J Townend
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Leigh Rutherford
- General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
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