Acid Corrosive Injury in Patients with a History of Partial Gastrectomy: Outcome Analysis

Abstract

Background: Our purpose was to delineate the characteristics and outcome of acid-corrosive injury in patients with a history of gastric resection. Material and Methods: A total of 359 patients with a history of acid-corrosive injury were retrospectively reviewed. They were grouped based on past history with group 1 consisting of 8 patients with a history of gastric surgery (6 hemigastrectomies with Billroth II gastrojejunostomy, 2 partial gastrectomies with Billroth I gastroduodenostomy) and group 2 consisting of 351 patients without a history of previous gastric surgery. Clinical data, operative findings, treatment modalities and prognoses were compared. Results: Group 1 patients required significantly more emergency surgical interventions (p = 0.016) and more frequent resection of alimentary necrosis (p = 0.007). In the operative findings of those undergoing emergency laparotomy, group 1 had a slightly higher incidence of total gastric necrosis with or without perforation (p = 0.388), and a higher incidence of jejunal resection (p = 0.001). However, group 1 patients had a relatively lower operative mortality rate compared to group 2 patients (p = 0.640). Conclusion: Acid-injured patients with a history of previous gastric surgery tended to have a higher incidence of mandatory emergency surgical exploration and resection of the alimentary tract. With early and prompt management, a good survival rate can still be anticipated.

Isolated Full Thickness Jejunal Necrosis Following Sulphuric Acid Cocktail Ingestion – A Clinical Case Report—Isolated Corrosive Jejunal Necrosis

“…Characteristic features in acid ingestion include severe injury to the stomach, particularly antropyloric region and relative sparing of the oesophagus. However following gastric surgeries involving pyloric ablation, ingested acid can enter the small intestine rapidly and can cause significant injury [8]. Due to contact burns and bitter taste concentrated acids are usually vomited out thereby producing lesser damage whereas dilute acids will be ingested in relatively larger amount and can lead to significant injury of the digestive tract [4].…”

Caustic ingestion: development and validation of a prognostic score

“…According to our score, integrating mucosal assessment with the analytical expression of the transmural lesion improves the ability to identify cases with worse evolution and overcomes the limitations of an evaluation based only on endoscopy. Since leukocytosis and acidosis are very effective in identifying severe cases, we recommend performing these analysis whenever clinical complications are suspected (impaired clinical status, respiratory involvement or severe endoscopic injury).Several studies have evaluated the predisposing factors for poor evolution after caustic damage[26][27][28], the impact of symptoms on prognosis[1][2][3][4][5][6][7][8][9][10][11]14,29] and the predictive ability of endoscopy [2,23,30-34]. However, several of these studies contain methodological limitations, due to their retrospective design, possible selection biases (some studies include only admitted patients or those who have undergone endoscopy), and the fact that most of their results have not 15 Accepted Manuscript Accepted Manuscript been validated.…”