Corrosive Injury of the Upper Gastrointestinal Tract: Review of Surgical Management and Outcome in 14 Adult Cases

Document Type: Original

Authors

1 Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Cardio- Thoracic Surgery & Transplant Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Surgical Oncology Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

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 Nov1993 to march 2011, 14 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:
14 patients (10men and 4 women) with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 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 2 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


1. Hugh B, Thomas Kelly D. Michael Corrosive ingestion and the surgeon J Am Coll Surg 1999; 189(5): 508-22.

2. Wu Ming-Ho, lai Wu-wei. Esophageal reconstruction for esophageal strictures or resection after corrosive injury. Ann Thoracic Surg 1992; 53(5): 798-802.

3. Browne Y, Dale, Thompson N. James. Caustic ingestion in the book of pediatric otolaryngology head & neck surgery edited by Charles W. Cummings, John M. Fredrickson, Lee A. Richardson, David E. Schuller, 3th edition, volume 5 Mosby-year book Inc 1998: 366-76.

4. Spiegel Joseph R, Sataloff Robert Thayer. Caustic injury of the esophagus in the book of the esophagus edited by D.O. Castell, J. E. Richter 3th ed. Lippincott Williams & Wilkins Philadelphia 1999: 564-77.

5. Thomas Arthur N, Dedo Herbert H, Lim Robert C Jr, Steele Muriel. Pharngoesophageal caustic stricture. Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft. Am J Surg 1976; 132(2): 195-203.

6. Doolin Edward J. Composite reconstruction of the Esophagus and hypopharynx after severe caustic injury. Ann Otorhinol Laryngol 1994; 103: 36-40.

7. Panieri E, Rode H, Millar AJW, Cywes S. Oesophageal replacement in the management of corrosive strictures: when is surgery indicated? Pediatr Surg Int 1998; 13: 336-40.

8. Postlethwait RW. Colon interposition for esophageal substitution. Surg, Gynecol & Obstet 1983; 156(3): 377-83.

9. Nicosia Jon F, Thornton Joseph P, Folk Frank A, Saletta John D. Surgical management of corrosive gastric injuries. Annals of Surgery 1974; 180(2): 139-43.

10. Estrera Aaron, Taylor Wayne, Millis Lawrence. J. Corrosive burns of the Esophagus and stomach: A recommendation for an aggressive surgical approach. Annal Thorac Surg 1986; 41(3): 276-83.

11. Jeng Long Bin Benjamin, Chen Hoang-Yang, Chen Shin - Chen, Hwang Tsann-Long, Jan Yi-Yin, Wang Chia-Siu, Chen Miin-Fu. Upper gastrointestinal ablation for patients with extensive injury after ingestion of strong acid. Arch Surg 1994; 129(10): 1086-90.

12. Ashcraft Keith W. Chemicals Esophageal injuries in the book of pediatric surgery edited by Ashcraft, Murphy, Sharp, Sigalet, Synder 3th edition W. B Saunders Company 2000; 325-347.

13. Dilawari JB, Singh Surjit, Rao PN, Anand BS. Corrosive acid ingestion in man-a clinical and endoscopic study. GUT 1984; 25(10): 183-7.

14. Ferguson Mark K, Marcello Migliore, Staszak M. RN, Little Alex.G. Early evaluation and therapy for caustic esophageal injury. Am J Surg 1989; 157(1): 116-20.

15. Peters Jeffrey H, Demeester Tom R. Caustic injury in the principles of surgery edited by Schwartz, Shires, Spencer, Daly, Fischer, Galloway volume ΙΙ 7th edi McGraw-Hill 1999; 1158-61.

16. Ho-Wu Ming, Lai Wu-Wei, Lin Mu-Yen, Chou Nan-Song. Prevention and management of strictures after hypopharyngocolostomy or esophagocolostomy. Ann Thoracic Surgery 1994; 58(1): 108-11.

 17. Brun JG, Koskas F, Dubost C. Blunt thorax oesophageal stripping: Am emergency procedure for caustic ingestion. Br J Surg 1984; 71(9): 698-700.

 18. Horvath Ors P. Tiborolah, Gabriella Zentai. Emergency Esophagogastrectomy for treatment of hydrochloric acid. Ann Thorac Surg 1991; 52(1): 98-101.

19. Cebeci Hayrettin, Paksoy Melih, Kaytaz Asim, Unal Ethem. Cololaryngostomy procedure in caustic esophageal burns. Eur J Cardio-Thorac Surg 2002; 21(1): 136-9.

20. Howu Ming, Tseng Yau-Lin, Lin Mu-Yen, Lai Wu-Wei. Esophageal reconstruction for hypopharyn- goesophageal strictures after corrosive injury. European J Cardio-Thoracic Surg 2001; 19: 400-5.

21. Ferguson Mark. K. the colon as a reconstructive organ In the book of reconstructive surgery of the esophagus edited by Mark K. Ferguson Futura publishing Company inc. 2002; 161-3.

22. Harlak A, Yigit T, Coskun K, Ozer T, Mentes O, Gülec B, Kozak O. Surgical treatment of caustic esophageal strictures in adults. Int J Surg. 2013; 11(2):164-8.