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Article
October 1994

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

Author Affiliations

From the Department of Surgery, Chang Gung Medical College, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

Arch Surg. 1994;129(10):1086-1090. doi:10.1001/archsurg.1994.01420340100019
Abstract

Objective:  Extensive corrosive injury involving the structures beyond the pylorus caused by ingestion of strong acid has a poor prognosis. We reviewed six cases of patients who underwent total upper gastrointestinal tract ablation to see the effect of this extensive procedure for such an injury.

Design:  Case series.

Setting:  Tertiary care center.

Patients:  Six patients who ingested more than 250 mL of 20N hydrochloric acid were treated in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China, from 1986 to 1992.

Results:  Three patients with preoperative metabolic acidosis and renal failure died of multiple organ failure within the first postoperative month. The other three patients survived the acute stage. While being readied for a late reconstructive procedure, sepsis developed in one patient due to cholecystostomy leakage about 1 year postoperatively. Another patient died of respiratory failure after development of aspiration pneumonia due to poor drainage of a spit fistula, after surviving for 6 months. Only one patient had a good recovery following a full reconstruction procedure and restoration of the continuity of the gastrointestinal tract.

Conclusions:  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.(Arch Surg. 1994;129:1086-1090)

References
1.
Gumaste VV, Dave PB.  Ingestion of corrosive substances by adults . Am J Gastroenterol . 1992:87:1-5.
2.
Galdman LP, Weigert JM.  Corrosive substance ingestion: a review . Am J Gastroenterol . 1984;79:85-90.
3.
Zargar SA, Kochhar R, Nagi B, et al.  Ingestion of corrosive acids: spectrum of injury to upper gastrointestinal tract and natural history . Gastroenterology . 1989; 97:702-707.
4.
Nicosia JF, Thornton JP, Folk FA, et al.  Surgical management of corrosive gastric injuries . Ann Surg . 1974;180:139-143.Article
5.
Sugawa C, Lucas CE.  Caustic injury of the upper gastrointestinal tracts in adults: a clinical and endoscopic study . Surgery . 1989;106:802-806.
6.
Hwang TL, Shen-Chen SM, Chen MF.  Nonthoracotomy esophagectomy for corrosive esophagitis with gastric perforation . Surg Gynecol Obstet . 1987;164: 537-540.
7.
Brun JG, Celerier M, Koskas F, Dubost C.  Blunt thorax esophageal stripping: an emergency procedure for caustic ingestion . Br J Surg . 1984;71:698-700.Article
8.
Chong GC, Beahrs OH, Payne WS.  Management of corrosive gastritis due to ingested acid . Mayo Clin Proc . 1974;49:861-865.
9.
Dilawari JB, Singh S, Rao PN, et al.  Corrosive acid ingestion in man: a clinical and endoscopic study . Gut . 1984;25:183-187.Article
10.
Fisher RA, Eckhauser ML, Radivoyevitch M.  Acid ingestion in an experimental model . Surg Gynecol Obstet . 1985;161:91-99.
11.
Estrera A, Taylor W, Mills LJ, et al.  Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach . Ann Thorac Surg . 1986;41:276-283.Article
12.
Cardona JC, Daly JF.  Current management of corrosive esophagitis: an evaluation of 239 cases . Ann Otol . 1971;80:521-527.
13.
Ganepola GAP, Bhuta K.  A case of total esophago-gastro-duodeno-jejunectomy and partial pancreatectomy for lye burns, and reconstruction with colon interposition . J Trauma . 1984;24:913-916.Article
14.
Maull KI, Scher LA, Greenfield LJ.  Surgical implications of acid ingestion . Surg Gynecol Obstet . 1979;148:895-898.
15.
Huy PTB, Celerier M.  Management of severe caustic stenosis of the hypopharynx and esophagus by ileocolic transposition via suprahyoid or transepiglottic approach: analysis of 18 cases . Ann Surg . 1988;207:439-445.Article
16.
Popovici Z.  Pharyngeal-oesophageal reconstruction with laryngeal preservation following severe caustic injury to the pharynx and esophagus . In: Hennessy TPJ, Cushieri A, eds. Surgery of the Oesophagus . 2nd ed. Stoneham, Mass: Butterworths-Heinemann; 1993;11:328-350.
17.
Chen HC, Tang YB, Noordhoff MS.  Patch esophagoplasty with free forearm flap for focal stricture of the pharyngoesophageal junction and the cervical esophagus . Plast Reconstr Surg . 1992;90:45-52.Article
18.
Chen HC, Tang YB, Noordhoff MS.  Posterior tibial artery flap for reconstruction of the esophagus . Plast Reconstr Surg . 1991;88:980-986.Article
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