Necrosis of the stomach secondary to ingestion of corrosive agents: report of three cases requiring total gastrectomy

Acid corrosive gastritis. A plea for delayed surgical approach

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.

Acid ingestion: toxicology and treatment

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.

Emergency management and sequelae of acid ingestion

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.