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

Abstract

Isolated involvement of the lower gastrointestinal tract with relative sparing of the oesophagus and the stomach is extremely rare following corrosive agent ingestion. We report a case of isolated full thickness jejunal necrosis following sulphuric acid cocktail ingestion. A 42 year old man presented with history of consuming 200ml of sulphuric acid mixed with alcohol, with suicidal intent. On exploration there were multiple, full thickness necrotic areas in the proximal jejunum with minimal congestion of the oesophagus, stomach and duodenum. Inversion of the jejunal necrotic areas with feeding jejunostomy was carried out. However postoperatively patient developed progressive pulmonary insufficiency with features of sepsis and expired on the nineteenth day following a bout of massive haematemesis. Corrosive agents when taken in considerable amount mixed with other fluids can lead to full thickness small bowel necrosis with relative sparing of the proximal gastrointestinal tract

Corrosive Ingestion

“…However, this protective mechanism is lost in patients with ingestion of a large quantity of corrosive or history of prior gastric surgeries like pyloroplasty or gastric bypass, resulting in damage to the small bowel. 5 While the amount of ingested corrosives influences the extent of damage, reliable information of the ingested quantity is seldom available. Also, it is important to understand that corrosives like phosphoric and hydrofluoric acid can cause systemic effects such as severe hypocalcemia, hypokalemia, and acidosis.…”

Isolated jejunal necrosis following corrosive acid poisoning

“…[7][8][9][10] There has been a case report in the literature where patient had an isolated jejunal perforation following corrosive acid poisoning. 3 However, our patient had isolated jejunal necrosis without any other injuries. Our patient underwent jejunal resection with end-to-end anastomosis.…”

“…Suicidal ingestion of corrosive substances will have predominant oral, pharyngeal, and upper esophageal lesions, whereas accidental ingestion has predominant gastric injuries, although esophageal injuries may be associated. 3 Isolated involvement of the lower gastrointestinal tract is infrequent. In our patient, there was isolated jejunal necrosis with a normal-appearing stomach and duodenum.…”

“…Patients usually present with abdominal pain, breathlessness, tachycardia, and vomiting. 3 Radiological investigations help to grade the severity of the injury. Surgical management is helpful in patients who are not stable.…”

A case of severe upper alimentary tract necrosis by corrosive acid poisoning

“…There is a case report in literature where isolated full-thickness jejunal perforation was seen following sulphuric acid and cocktail ingestion. 8 Acute gastric injury is seen mainly in the distal stomach, ranging from mucosal injury to perforation. Rarely the stomach gets necrosed.…”