Emergency management of caustic ingestion in adults

Abstract

A study of 57 patients admitted to the Department of Emergency Surgery at the Ospedale Maggiore in Milan between 1980 and 1992 following the recent ingestion of a caustic substance is presented herein. Through this study, an aggressive diagnostic and therapeutic approach has been employed, including early surgery which plays a fundamental role in the prevention of acute hemorrhagic or perforative complications as well as in the development of scar tissue and neoplastic strictures over time. The criteria for early emergency surgery were the presence of endoscopic grade 3 and 4 lesions as well as those on the borderline between grades 2 and 3 with clinical symptoms. In 11 patients with lesions of moderate severity, the treatment of choice was medical therapy, which required subsequent surgical intervention for strictures in 5 patients. In 13 patients with severe lesions, an early surgical approach was performed with a mortality rate of 23%.

Caustic injuries of the upper digestive tract: a population observational study

“…Accordingly, most referral centers have developed aggressive management protocols and offer emergency surgery to patients with severe injuries [2,14,20,22]. As a result of the implementation of such aggressive treatment strategies, overall mortality and morbidity rates after caustic ingestion have decreased significantly [2,14,20,22,23]. This is a homogeneous series of 315 consecutive patients evaluated for caustic injuries after corrosive ingestion over a 6-year period at a tertiary referral center.…”

“…Age, sex, corrosive ingestion with suicidal intent, the nature and quantity of the ingested agent, the time of exposure, the delay before treatment, and the endoscopic grading of injuries of the gastrointestinal tract have been identified as predictive factors for severe injuries [14,[18][19][20][21]. Accordingly, most referral centers have developed aggressive management protocols and offer emergency surgery to patients with severe injuries [2,14,20,22]. As a result of the implementation of such aggressive treatment strategies, overall mortality and morbidity rates after caustic ingestion have decreased significantly [2,14,20,22,23].…”

“…Complications such as hemorrhage, digestive perforation, aortoenteric fistula, or gastrocolic fistula may occur in patients surviving the initial event during the first 2-3 weeks after ingestion [6,9]. In the long term, development of pharyngeal, esophageal, or gastric strictures may compromise nutritional outcome [2,5,[9][10][11].…”

“…Most patients present with mild injuries that recover without sequels, but injuries due to massive ingestion of strong corrosive substances result in high mortality rates [2][3][4][5][6][7][8]. Complications such as hemorrhage, digestive perforation, aortoenteric fistula, or gastrocolic fistula may occur in patients surviving the initial event during the first 2-3 weeks after ingestion [6,9].…”

Respiratory Complications from Acute Corrosive Poisonings in Adults

“…For the evaluation of the extend of the damage caused by the ingestion of these substances, one needs to be aware of the reason for the ingestion, the nature and the amount of the ingested substance, the length of the exposure, how long before the patient is treated and the sex and age of the patient (14,15). Most hospitals across the globe use aggressive methods and protocols, both conservative and surgical, for the treatment of patients with corrosive poisonings, consequently the rate of mortality and morbidity has significantly decreased in the past several years (16,17).…”