Corrosive acid ingestion in man - a clinical and endoscopic study.

Dilawari, J. B.; Singh, Surjit; Rao, Prithviraj; Anand, B S

doi:10.1136/gut.25.2.183

Cited by 47 publications

(31 citation statements)

References 14 publications

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“…Surgery was usually performed 7–10 days after the UGI examination. Varying degrees of residual mucosal inflammation of the gastric remnant were noted for 80% of our patients during surgery; however, edema or contraction of the stomach did not preclude gastric resection [19, 20, 21]. From analysis of the study data, it was demonstrated that antral strictures were more common than the gastric body variant.…”

Section: Discussionmentioning

confidence: 91%

Early Surgical Correction for Isolated Gastric Stricture following Acid Corrosion Injury

Tseng

et al. 2002

Dig Surg

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Objective: To evaluate the feasibility and long-term results of early gastric surgery for patients with isolated gastric stricture following acid corrosion injury. Materials and Methods: Upper gastrointestinal (UGI) series was routinely performed around the 4th week after acid corrosion injury. Patients with gastric stricture and no risk of delayed esophageal stricture underwent early solitary gastric surgery, which was defined when performance of the procedure took place within 2 months of the injury. Results: From June 1988 to June 2000, 35 of 378 patients with acid corrosion injury developed isolated gastric stricture. Twenty-four (68.6%) lesions were located in the antrum, and 11 (31.4%) in the gastric body. Postprandial vomiting presented earlier for the antral stricture group (17.6 ± 1.1 versus 25.4 ± 3.4 days after injury; p = 0.005). The UGI series was performed from 16 to 41 days after injury (average 25 days). Of the 35 acid corrosion injury patients in this study, 4 were excluded because of late referrals to our institution or the patient’s hesitation which resulted in delayed surgery. The remaining 31 patients underwent gastric surgery 35.7 ± 3.2 days after ingestion (34.6 ± 3.6 and 38.1 ± 3.4 days for cases of antral and gastric body stricture, respectively). Surgical procedures consisted of hemigastrectomy (n = 16), antrectomy (n = 2), gastroenterostomy (n = 2), subtotal gastrectomy (n = 6), and total gastrectomy (n = 5). There were 4 cases of postoperative complications (12.9%) including adhesion ileus (n = 2), wound infection (n = 1), and massive, postoperative UGI bleeding (n = 1). Surgical mortality was zero. All patients tolerated oral intake well after surgery. During the minimum follow-up period of 1 year, 1 patient developed esophagojejunostomy stenosis, which was resolved by dilation, and there was 1 case of dumping syndrome, which was treated by diet control. Conclusion: Early surgery correction is feasible and safe if patients with isolated gastric stricture following acid corrosion injury are carefully selected. All patients in our study recovered early, with a low morbidity rate.

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Section: Discussionmentioning

confidence: 91%

Early Surgical Correction for Isolated Gastric Stricture following Acid Corrosion Injury

Tseng

et al. 2002

Dig Surg

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“…Exposures to both acids and alkalis through ingestions can result in a wide variety of presentations, severity, and complications [4].…”

Section: Discussionmentioning

confidence: 99%

A complicated hospitalization following dilute ammonium chloride ingestion

et al. 2009

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Introduction: Unintentional ingestions of dilute (<7.5%) cleaning solutions containing ammonium chloride typically do not cause serious harm. We present a case of an intentional ingestion of a dilute ammonium chloride solution resulting in significant morbidity.Case Report: A 60-year-old woman with bipolar disorder presented one hour after an intentional ingestion of approximately 15 fluid ounces (500 mL) of an algae and odor humidifier treatment containing a total of 2.25% ethyl ammonium chloride. Initial complaints included nausea with a single episode of nonbilious, nonbloody emesis, mild shortness of breath, and chest and epigastric pain. Physical exam was remarkable for bilateral wheezing and epigastric tenderness. An emergent endoscopy demonstrated a Grade 2b caustic injury in the esophagus and a Grade 3b injury in the stomach. Due to persistent cough, copious oral secretions, and worsening hoarseness, the patient was intubated and admitted to the ICU. Her course was complicated by mild hypotension, nonanion gap metabolic acidosis, and oliguria treated successfully with intravenous (IV) fluids. She also developed bilateral pneumonias later in the hospital course. Bedside bronchoscopy showed laryngeal edema and mucosal injury to the segmental level. The patient underwent tracheostomy on hospital day 6. An upper GI swallow study revealed poor esophageal motility in the mid-to lower third of the esophagus. The patient gradually tolerated oral fluids and on hospital day 20 had her tracheostomy tube removed. The patient was subsequently transferred to the psychiatric ward on hospital day 22.Conclusion: Intentional ingestions of dilute ammonium chloride solutions can cause serious injury to the gastrointestinal tract and pulmonary systems, which can result in a complicated and prolonged hospitalization.

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“…Contrary to the situation in Western countries where alkali-induced strictures are more common, acid has been found to be a more frequent cause of strictures in India. Acid ingestion has been found to be a cause in less than 5% of the stricture cases in United States, while in India it has been found to be involved in about 70%-80% [4,[13][14][15][16]. Most of the ingestions in India are accidental rather than suicidal [15].…”

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confidence: 97%

Management of Acid- and Alkali-Induced Esophageal Strictures in 79 Adults by Endoscopic Dilation: 8-Years’ Experience in New Delhi

Singhal

Kar

2007

Dysphagia

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Experience with endoscopic dilation of acid- and alkali-induced strictures of the esophagus using Savary-Gilliard (SG) and balloon dilators is limited, especially in adults. The aim of this study was to determine the safety and efficacy of endoscopic dilation in the management of corrosive esophageal strictures and to compare results with regard to acid- vs. alkali-induced strictures. The records of 230 patients who were treated by endoscopic dilation between 1997 and 2005 at our center were reviewed. This study included all the patients who had corrosive-induced esophageal strictures. SG dilators were used in most of our patients [67/79 (85%)], while only a few patients [12/79 (15%)] were treated with balloon dilators. Dilation was found to be successful after an initial course of dilation (not requiring further dilations) in 28/37 (75.67%) cases in the SG dilator group and in 9/12 (75%) in the balloon group. Strictures caused by acids required a greater mean number of dilations for initial relief of dysphagia compared with that for alkalis. Some of these patients responded to a second course of dilation, leading to final combined SG dilator and balloon dilator success rates of 24/28 (86%) in the acid group and 17/21 (81%) in the alkali group. A total of 359 sessions of dilations were performed with a complication rate of 2/359 (0.56%). Endoscopic dilation using Savary-Gilliard and balloon dilators is safe and effective in managing corrosive esophageal strictures, but it is operator-dependent and the final outcome depends largely on the technical expertise and appropriate selection of patients.

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Corrosive acid ingestion in man - a clinical and endoscopic study.

Cited by 47 publications

References 14 publications

Early Surgical Correction for Isolated Gastric Stricture following Acid Corrosion Injury

Early Surgical Correction for Isolated Gastric Stricture following Acid Corrosion Injury

A complicated hospitalization following dilute ammonium chloride ingestion

Management of Acid- and Alkali-Induced Esophageal Strictures in 79 Adults by Endoscopic Dilation: 8-Years’ Experience in New Delhi

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