Upper Gastrointestinal Tract Ablation for Patients With Extensive Injury After Ingestion of Strong Acid

Abstract

Three of six patients died in the hospital. The risk factors were preoperative metabolic acidosis, renal failure, and an upper jejunal resection greater than 100 cm in length. Early and aggressive approaches to resect all the necrotic tissue certainly provide good chances to survive the acute stage and later reconstruction.

Total Gastrointestinal Tract Necrosis After Ingesting a Considerable Amount of Hydrochloric Acid

“…The reported volume of ingestion of strong acid ranged from 80 to 500 mL. 1,3,4 The amount of hydrochloric acid ingested by this patient was quite large, it would be reasonably to believe that it would lead to severe consequences. It is also scarce that the CT image show significant free air in the neck, lateral esophagus, and abdominal cavity simultaneously.…”

Acid Corrosive Injury in Patients with a History of Partial Gastrectomy: Outcome Analysis

“…The duodenum and afferent loop of the jejunum were spared. Duodenal injury remains the critical point in extensive surgery of acid-corrosive injury because inevitably, associated injury of the pancreas and common bile duct makes the operation technically demanding and often complicates the subsequent clinical course, for example leakage and further chemical peritonitis, intra-abdominal abscess, sepsis and other respiratory and abdominal complications [7, 11, 18]. Without duodenal involvement, acid-injured patients usually have favorable surgical results.…”

Corrosion injury of the upper gastrointestinal tract after swallowing strong alkali

“…Estrera et al (5) observed that missed or delayed diagnoses of full-thickness oesophagogastric necrosis with its prohibitive mortality can be avoided by adopting a more aggressive surgical approach and radically resecting all necrotic tissue. When extensive third degree injury is found at endoscopy or when there is a clear evidence of perforation, surgical intervention is indicated (9,13) rather than observation. The stomach or the oesophagus may perforate at any time during the first 2 weeks, and the operations ought to be done before that.…”

“…Because there is a thousand-fold increase in the incidence of oesophageal cancer after lye ingestion, patients with corrosion injury of the oesophagus should be kept under surveillance that includes regular oesophagoscopy, cytologic study of washings, and biopsy, particularly if more than 20 years have elapsed since the injury (8). Most of these cancers occur at the level of the carina (1,9), and these patients have a better prognosis than patients with oesophageal cancer who have not had a caustic injury of the oesophagus (12).…”