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

• Main Authors: Mohammad Taghi Rajabi, Ghodratollah Maddah, Reza Bagheri, Mostafa Mehrabi, Hossein Shabahang, Farjad Lorestani
• Format: Article
• Language: English
• Published: Mashhad University of Medical Sciences 2015-01-01
• Series: Iranian Journal of Otorhinolaryngology
• Subjects: Caustic ingestion; Esophageal replacement; Esophageal stricture
• Online Access: http://ijorl.mums.ac.ir/pdf_3419_8153ed2c4061051d94ec59a891ba4b94.html

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.