Caustic ingestion injury of the upper aerodigestive tract in adults

Rollin, Matthew; Jaulim, Adil; Vaz, Francis; Sandhu, Gurpreet S.; Wood, Simon; Birchall, Martin A.; Dawas, Khaled

doi:10.1308/003588415x14181254789286

Cited by 22 publications

(19 citation statements)

References 25 publications

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“…Several diagnostic and therapeutic recommendations have been implicated over the last years. [23,24] Nevertheless, a comparison of acidic and alkaline agent ingestion in adults with regard to clinical management, outcome, and survival has not been performed. With this in mind, we retrospectively analyzed all adults with caustic ingestion in our tertiary medical center from 2005 to 2016.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults

Hollenbach¹,

Tünnemann²,

Struck

et al. 2019

Medicine

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Caustic ingestion in adults is a rare but potentially life-threatening problem. It remains controversial whether endoscopic findings and mortality differ between acid and alkali ingestion. We compared ingestion of these agents and evaluated prediction parameters for survival and complications.Adult patients who presented with caustic ingestion were analyzed from 2005 to 2016. Mucosal injury was graded endoscopically by Zargar's score. Age, gender, intent of ingestion, caustic agents, comorbidities, management, complications, and mortality were examined.Thirty-one patients met inclusion criteria and were divided into acid (n = 10) and alkali group (n = 21). Ingestion of alkali resulted in higher grades (≥III) of esophageal (56% vs 24%, P = .01) and stomach injuries (43% vs 13%, P = .05) and was mostly done with suicidal intent (76% vs 30%, P = .003). Patients in the alkali group received more often surgical interventions, mechanical ventilation and tracheotomy. Overall complications including Zargar's-score ≥ grade III, mediastinitis, and aspiration pneumonia were higher in alkali group but all showed no statistical significance (P = .73). Mortality (acid: 1 (10%), alkali: 4 (19%), P = .52), age, gender, comorbidities, and intensive care management did not differ significantly between the groups. Chronic renal failure and mediastinitis were promising prediction parameters for mortality but did not reach statistical significance. No independent risk factors for the development of esophageal stenosis were identified.Alkaline agents caused a higher mucosal injury severity and were more often used in suicidal intent. Mediastinitis and chronic renal failure might be potential prediction parameters for survival but need to be evaluated in larger studies.

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Section: Discussionmentioning

confidence: 99%

Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults

Hollenbach¹,

Tünnemann²,

Struck

et al. 2019

Medicine

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“…Mortality after caustic ingestion is high worldwide and ranges from 5% to 20% [ 3 , 5 , 7 , 9 , 21 , 22 ]. In our study the mortality rate was 15.3%.…”

Section: Discussionmentioning

confidence: 99%

Caustic Ingestion in the Elderly: Influence of Age on Clinical Outcome

et al. 2017

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Caustic poisonings are still associated with many fatalities. Studies focusing on the elderly are rare. The purpose of the present study was to compare the clinical outcomes of caustic ingestion injury in elderly and non-elderly adults with regard to gender, intent of exposure, substance ingested, severity of mucosal injury, complications, and mortality. Caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during 1998–2015 were reviewed retrospectively. The patients were divided into two groups: the non-elderly (<60 years) and elderly adults (≥60 years). The mortality rate in the elderly was significantly higher (elderly 23.0% vs. non-elderly 11.3%; p = 0.041). The risk of fatal outcome in the elderly was increased by acid ingestion (OR = 7.822; p = 0.002), particularly hydrochloric acid (OR = 5.714, p = 0.006). The incidence of respiratory complications was almost two times higher in the elderly was 31.1% vs. 17.4% for the non-elderly (p = 0.037). Respiratory complications significantly correlated with an increased mortality rate (p = 0.001) in the elderly whereas there was no association between GI complications and mortality in the elderly (p = 0.480). Elderly patients with respiratory complications had the poorest clinical outcomes. The highest risk of complications and fatalities was observed in patients after hydrochloric acid ingestion.

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“…In contrast to children, whose poisoning is mainly accidental, a suicide attempt is the usual cause of caustic ingestion in adults, especially among teens, and psychiatric and alcoholic patients 7,8…”

Section: Discussionmentioning

confidence: 99%

“…Most of the cases in which the intent is to commit suicide include teens and young adults in their 20s, and psychiatric and alcoholic patients 7,8…”

Section: Introductionmentioning

confidence: 99%

Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Lepore¹,

D’Antini²,

Raimondo³

et al. 2016

IMCRJ

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Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy.

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Caustic ingestion injury of the upper aerodigestive tract in adults

Cited by 22 publications

References 25 publications

Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults

Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults

Caustic Ingestion in the Elderly: Influence of Age on Clinical Outcome

Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

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