Esophagojejunostomy after total gastrectomy for caustic injuries

Chirica, Mircéa; Kraemer, Aurore; Petrascu, E.; Vuarnesson, H.; Pariente, Benjamin; Halimi, Bruno; Munoz‐Bongrand, Nicolas; Sarfati, E.; Cattan, Pierre

doi:10.1111/dote.12079

Cited by 19 publications

(15 citation statements)

References 17 publications

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“…Decisively, every effort possible should be made to mature a feeding jejunostomy at the initial operation, to provide enteral feeding and avoid parenteral nutrition, which are known to prolong hospital stay, and increase the risk of infections [ 10 , 11 ]. Although some authors have advocated immediate restoration of the GI tract with esophagojejunostomy, this option should only be used for stable patients with minimal intraperitoneal soiling [ 12 ]. On the contrary, restoration of the GI tract should be performed as soon as the patient has recovered from the systemic insult of the caustic injury.…”

Section: Discussionmentioning

confidence: 99%

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

et al. 2016

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Case seriesPatient: Fenale, 77 • Female, 46 • Female, 33Final Diagnosis: Caustic injurySymptoms: —Medication: —Clinical Procedure: SurgerySpecialty: SurgeryObjective:Unusual clinical courseBackground:Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae.Case Report:The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies.Conclusions:Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

et al. 2016

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“…If necrosis is confined to the stomach, total gastrectomy with preservation of the native esophagus or esophageal diversion should be considered [38]. Immediate esophagojejunostomy reconstruction can be performed safely with low leak rates (5–8%) [64]. Partial gastric resections are not recommended because ongoing necrosis might compromise patient survival.…”

Section: Methodsmentioning

confidence: 99%

Esophageal emergencies: WSES guidelines

et al. 2019

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The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

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“…The literature research revealed the need for standardised therapeutic strategies in case of caustic ingestion, particularly since there are no randomised controlled trials and the majority of published data consist of literature reviews and retrospective studies exhibiting a low evidence level 9 18. However, a retrospective analysis indicated that immediate oesophagojejunostomy after total gastrectomy might represent a safe therapeutic option 19. A three-stage surgical procedure including total gastrectomy and concomitant oesophagojejunostomy after caustic ingestion has been reported recently 20.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of gastric necrosis after ingestion of hydrochloric acid: a two-stage minimally invasive surgical procedure

et al. 2019

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Caustic ingestion may cause devastating injuries of the upper gastrointestinal tract and the respiratory system. We report here the successful treatment of a 37-year-old patient who ingested hydrochloric acid (100 mL; 24%) in suicidal intention. An oesophagogastroduodenoscopy revealed extensive necrosis of the gastric mucosa. A diagnostic laparoscopy was performed and confirmed the suspected transmural necrosis which resulted in a discontinuous laparoscopic gastrectomy. During the next days, the oesophageal stump was monitored through frequent oesophagoscopies and showed a good recovery. Thus, it was possible to restore continuity as early as by the sixth postoperative day performing a roux-en-y oesophagojejunostomy using the da Vinci Xi surgical robot. The patient underwent all procedures without any surgical complications and was discharged almost 1 month after initial presentation in good general condition.

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Esophagojejunostomy after total gastrectomy for caustic injuries

Cited by 19 publications

References 17 publications

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

Esophageal emergencies: WSES guidelines

Successful treatment of gastric necrosis after ingestion of hydrochloric acid: a two-stage minimally invasive surgical procedure

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