Corrosive Injury of the Upper Gastrointestinal Tract: Review of Surgical Management and Outcome in ۱۴ Adult Cases

Introduction: Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion.   Materials and Methods: Between Nov۱۹۹۳ to march ۲۰۱۱, ۱۴ adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals). Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery.   Results: ۱۴ patients (۱۰men and ۴ women) with a age range between۱۸-۵۳ years were evaluated. In ۶ patients, the injury was accidental and in ۸ patients ingestion was a suicide attempt. Ingested agent included nitric acid in ۴ patients, hydrochloric acid in ۷ patients, sulfuric acid in ۲ patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in ۱۳ cases, stomach in ۷ cases and the pharynx in ۳ cases. Acute abdomen was developed In ۲ patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in ۲ patients, esophageal resection and replacement surgery in ۹ patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in ۲ survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient.   Conclusion:  Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.

Keywords:

Caustic ingestion , Esophageal replacement , Esophageal stricture