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1
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Chobarporn T, Mesiri D, Tharavej C. Long-term outcomes of patients undergoing emergency surgery for corrosive injury of the upper digestive tract. Surg Today 2025; 55:526-536. [PMID: 39177755 DOI: 10.1007/s00595-024-02928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Emergency surgery can save patients' lives in cases of severe caustic injury. However, the long-term outcomes are not well understood. METHODS Patients who underwent emergency organ resection for severe corrosive acid injury were included. Subsequently, digestive tract reconstruction was performed to fit patients. Long-term outcomes were analyzed. RESULTS Fifty patients underwent emergency digestive tract resection. The operative mortality rate was 6% (of 3/50). One of the 50 patients underwent successful immediate reconstruction. Of the 46 survivors with digestive tract discontinuity, 32 (70%) underwent subsequent reconstructive surgery, 10 (22%) died while awaiting reconstruction due to deterioration in their psychiatric and nutritional status, and 4 (9%) were unfit for reconstructive surgery. No operative mortality occurred during reconstruction. Among the 32 patients who underwent reconstruction, 30 (94%) achieved nutritional autonomy. Nutritional independence was achieved in 62% of the patients (31/50). At a median duration of 58 months, the median survival time of the 50 patients was 158 months. Patients who underwent reconstruction had a significantly better overall survival than those who did not (p < 0.0001). CONCLUSIONS Emergency surgery remains the standard treatment for corrosive ingestion of complicated digestive tract injuries. However, only 60% of survivors can undergo subsequent digestive reconstruction and achieve long-term nutritional autonomy and a survival outcome.
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Affiliation(s)
- Thitiporn Chobarporn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Dudsadee Mesiri
- Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Chadin Tharavej
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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2
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Kalayarasan R, Durgesh S. Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture. World J Gastrointest Surg 2023; 15:799-811. [PMID: 37342842 PMCID: PMC10277936 DOI: 10.4240/wjgs.v15.i5.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.
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Affiliation(s)
| | - Satish Durgesh
- Surgical Gastroenterology, JIPMER, Puducherry 605006, India
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3
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Chirica M, Bonavina L. Esophageal emergencies. Minerva Surg 2023; 78:52-67. [PMID: 36511315 DOI: 10.23736/s2724-5691.22.09781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France -
| | - Luigi Bonavina
- Medical School, Division of General Surgery, IRCCS San Donato Polyclinic, University of Milan, Milan, Italy
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4
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The comparison of alpha lipoic acid with methylprednisolone and sucralfate in subacute wound healing corrosive esophagus-induced rats: An experimental study. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:87-94. [PMID: 36926144 PMCID: PMC10012976 DOI: 10.5606/tgkdc.dergisi.2023.22694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/03/2022] [Indexed: 03/18/2023]
Abstract
Background This study aims to compare methylprednisolone frequently used in the therapeutic practices of corrosive esophagus burns, sucralfate, a protective material of mucosal surfaces, and alpha lipoic acid, the most potent antioxidant in a rat model. Methods A total of 40 female Sprague-Dawley rats were used in this study. The rats were equally divided into control, alpha lipoic acid, methylprednisolone, and sucralfate groups (n=10). A corrosive esophagus burn was created by using 10% pH:12 sodium hydroxide. No treatment was applied to the control group, and each group was given their own treatment. The treatment was continued regularly until the eighth day, when they were sacrificed. The corrosive esophagus burn lines were removed and tissue sections were stained with hematoxylin and eosin. Results The difference in ulceration in the group treated with alpha lipoic acid was significant, compared to the other groups. The most excellent complete epithelialization and complete re-epithelialization were observed in the alpha lipoic acid group. The difference between the groups was significant, with complete re-epithelialization being the lowest in the control and methylprednisolone groups (42.9% and 12.5%, respectively) and the highest in the alpha lipoic acid group (77.8%). In terms of ulceration and re-epithelialization, comparable values were found in the alpha lipoic acid group. The main difference was that the inflammation levels in the sucralfate group were lower and more favorable than the other groups in this period. The glutathione level was significantly higher in the alpha lipoic acid group and decreased the tissue hydroxyproline level. Conclusion Alpha lipoic acid reduces esophageal ulceration, severity and prevalence of inflammation, severity and prevalence of fibrosis, decreases tissue damage by increasing blood glutathione level, and also reduces stricture in corrosive esophagus burns in rats.
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5
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Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center. Surg Endosc 2022; 36:5660-5668. [PMID: 35790591 DOI: 10.1007/s00464-021-08781-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied. METHODS All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery. RESULTS During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases. CONCLUSION Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.
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Evaluation of a Diagnostic and Management Algorithm for Adult Caustic Ingestion: New Concept of Severity Stratification and Patient Categorization. J Pers Med 2022; 12:jpm12060989. [PMID: 35743772 PMCID: PMC9225358 DOI: 10.3390/jpm12060989] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Caustic ingestion has gained increasing attention worldwide. However, the insight into whether to use esophagogastroduodenoscopy (EGD) or computed tomography (CT) for first-line investigation remains controversial. This study aimed to evaluate a diagnostic and management algorithm that combines EGD and CT for rapid triage. Methods: We established an algorithm for our hospital in 2013, aiming to maximize the benefits and minimize the limitations of EGD and CT. Then, we retrospectively analyzed the 163 enrolled patients treated between 2014 and 2019 and categorized them into 4 groups: A = 3 (1.8%): with perforation signs and directly confirmed by CT, B = 10 (6.1%): clinically suspected perforation but not initially proven by CT, C = 91 (55.8%): initial perforation less favored but with EGD grade ≥ 2b or GI/systemic complications, and D = 59 (36.2%): clinically stable with EGD grade ≤ 2a, according to initial signs/symptoms and EGD/CT grading. The morbidity and mortality of each group were analyzed. The predictive values of EGD and CT were examined by logistic regression analyses and receiver operating characteristic (ROC) curves. Results: The outcomes of such algorithm were reported. CT was imperative for patients with toxic signs and suspected perforation. For non-emergent operations, additional EGD was safe and helpful in identifying surgical necessity. For patients with an initially low perforation risk, EGD alone sufficiently determined admission necessity. Among inpatients, EGD provided excellent discrimination for predicting the risk for signs/symptoms’ deterioration. Routine additional CT was only beneficial for those with deteriorating signs/symptoms. Conclusions: According to the analyses, initial signs/symptoms help to choose EGD or CT as the first-line investigative tool in caustic patients. CT is necessary for seriously injured patients, but it cannot replace EGD for moderate/mild injuries. The severity stratification and patient categorization help to simplify complex scenarios, accelerate decision-making, and prevent unnecessary intervention/therapy. External validation in a larger sample size is further indicated for this algorithm.
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7
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Biswas RS, Ray D. Outcomes of the management of corrosive injuries of the upper digestive tract in a tertiary care center. Dis Esophagus 2022; 35:doab096. [PMID: 35022679 DOI: 10.1093/dote/doab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 12/11/2022]
Abstract
Esophageal stricture is the most common delayed sequelae of aerodigestive tract corrosive injuries. Early endoscopic dilatation is an integral part of corrosive injury management. Self-dilatation of the esophagus is effective in preventing stricture recurrence. In this prospective study, we included patients with corrosive aerodigestive tract injury from January 2009 to December 2020. We analyzed the outcome of the endoscopic dilatation and self-dilatation treatments administered to patients with a corrosive esophageal stricture. Among 295 patients, 164 had an esophageal injury, 73 had esophago-gastric injury, 55 had a gastric injury, and 3 had the pharyngeal injury. Of the 295 patients, 194 (81.85%) underwent dilatation, and 13 patients with diffuse esophageal injury underwent upfront surgery. Successful dilatation was performed in 169 (87.11%) patients. Of the 68 patients undergoing self-dilatation, 63 patients achieved nutritional autonomy by 28 days. Early endoscopic dilatation effectively prevents surgery, and self-dilatation appears promising to prevent recurrent esophageal stricture.
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Affiliation(s)
- Ravi Shankar Biswas
- Department of Surgical Gastroenterology, Medical College Hospital, Kolkata, West Bengal, India
| | - Dipankar Ray
- Department of Surgical Gastroenterology, Medical College Hospital, Kolkata, West Bengal, India
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8
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Thongchuam C, Mahawongkajit P, Kanlerd A. The Effect of the COVID-19 on Corrosive Ingestion in Thailand. Open Access Emerg Med 2021; 13:299-304. [PMID: 34267561 PMCID: PMC8275177 DOI: 10.2147/oaem.s321218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Since January 2020, the outbreak of COVID-19 coronavirus has impacted global mental health, daily activities, and economies, including Thailand. The essential strategy is the disease-preventing measure of "lockdown." Corrosive ingestion is one of the most common forms of self-harm and problems worldwide. This study aimed to evaluate the effect of corrosive ingestion in the COVID-19 situation. METHODS This was a retrospective study of adult patients (≥18y) who had ingested corrosives and been admitted to surgical department, Thammasat University Hospital between June and December 2019 (pre-COVID-19) and January to June 2020 (COVID-19 period) and compared the epidemiological and clinical features between these two groups. RESULTS Nine and 20 patients were admitted in the pre-COVID-19 and COVID-19 periods, for an increase of 122%; males numbered 15. A minority of ingestions, 8/29, were intentional of which 7 were in the COVID-19 period. The Zargar classification showed a trend towards more gastric injury in the COVID-19 vs pre-COVID-19 periods: 8/17 vs 1/9 (p=0.09). Because of the endoscopic grade 0 in stomach was significantly higher in pre-COVID-19 than COVID-19 case (pre-COVID-19; 8 patients (88.9%), COVID-19; 9 patients (45%); p value 0.011). CONCLUSION Data from this study suggest increasing trends of corrosive ingestion and greater gastric injury during the COVID-19 period.
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Affiliation(s)
- Chatbadin Thongchuam
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
| | - Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University, Amphur Klongluang, Pathumthani, 12120, Thailand
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9
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Sümeli R, Cömert HSY, Sarıhan H, İmamoğlu M, Saygın İ. Effectiveness of Hypericum perforatum Extract in the Treatment of Corrosive Esophageal Burns. J INVEST SURG 2021; 35:647-652. [PMID: 33998353 DOI: 10.1080/08941939.2021.1921083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of our study is to determine the effectiveness of "Hypericum perforatum" extract in corrosive esophageal burns and to shed light on the search for new treatments. MATERIALS AND METHODS A total of 32 Sprague Dawley rats were separated into 4 groups. A standard esophageal burn model was created. Group 1 was identified as the sham group. Group 2 was burned and no treatment was performed afterward. Group 3 was burned and then 2 cc/day H. perforatum extract was given for 21 days. Group 4 was not applied any process and 2 cc/day H. perforatum extract was given for 21 days. The rats were sacrificed and biopsy specimens were taken for histopathological examination for the presence of inflammation, fibrosis, and necrosis. RESULTS There was a significant difference between groups in terms of inflammation, fibrosis, and necrosis. Furthermore, in the bilateral comparisons between the groups, there was a meaningful difference in terms of inflammation and fibrosis between Group 2 and Group 3. However, there was no meaningful difference between the same groups in terms of necrosis. CONCLUSION H. perforatum extract may be effective on inflammation, fibrosis, and necrosis in corrosive esophageal burns.
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Affiliation(s)
- Rezzan Sümeli
- Department of Pediatric Surgery of Istanbul Dr Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | | | - Haluk Sarıhan
- Department of Pediatric Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mustafa İmamoğlu
- Department of Pediatric Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - İsmail Saygın
- Department of Pathology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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10
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Supangat, Nugraha MY, Lundqvist P. Jaboulay gastroduodenostomy for pyloric obstruction after corrosive ingestion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Dorterler ME, Günendi T. Foreign Body and Caustic Substance Ingestion in Childhood. Open Access Emerg Med 2020; 12:341-352. [PMID: 33177894 PMCID: PMC7649222 DOI: 10.2147/oaem.s241190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Foreign body and caustic substance ingestion in childhood are common and require accurate and timely diagnosis to provide appropriate management consistent with the ingested substance/foreign body and clinical presentation as well as the associated risk status to prevent significant complications and morbidity. The aim of this paper was to present foreign body and caustic ingestion in childhood in terms of epidemiology, pathophysiology, diagnostic work-up and appropriate management and potential complications in accordance with clinical presentation and the type of ingested substance/foreign body.
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Affiliation(s)
| | - Tansel Günendi
- Harran University Faculty of Medicine, Department of Pediatric Surgery, Sanliurfa, Turkey
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12
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Chen YJ, Seak CJ, Kang SC, Chen TH, Chen CC, Ng CJ, Lee CW, Su MY, Huang HC, Chen PC, Ooyang CH, Hsieh SY, Cheng HT. A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years. Clin Toxicol (Phila) 2020; 59:409-417. [PMID: 33078983 DOI: 10.1080/15563650.2020.1822998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose. METHODS The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar's modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22. RESULTS Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ≥ 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids. CONCLUSION Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. "Large doses of acids" and "high pH of alkalis" deserve special attention. This new perspective with a retrospective nature requires further validation.
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Affiliation(s)
- Yu-Jhou Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yao Su
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Board of Directors and Supervisors, Taiwan Association for the Study of Small intestinal Disease (TASSID), Taoyuan, Taiwan
| | - Hsin-Chih Huang
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Pin-Cheng Chen
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chun-Hsiang Ooyang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hao-Tsai Cheng
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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13
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Chen YJ, Seak CJ, Chen CC, Chen TH, Kang SC, Ng CJ, Lee CW, Su MY, Huang HC, Ooyang CH, Hsieh SY, Cheng HT. The Association Between Caustic Ingestion and Psychiatric Comorbidity Based on 396 Adults Within 20 Years. Risk Manag Healthc Policy 2020; 13:1815-1824. [PMID: 33061714 PMCID: PMC7533265 DOI: 10.2147/rmhp.s272527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose High prevalence of psychiatric comorbidities (PCs) has been widely documented in caustic substance ingestion cases. However, their effect on the clinical features and prognostic outcomes remains unclear due to the paucity of discussion. We report on detailed clinical courses with long-term multifaceted outcomes and review the association between caustic ingestion and each specific PC. Patients and Methods The retrospective chart review included 396 adults (median follow-up, 16.6 months) with and 377 without (control group) PCs treated between 1999 and 2018 at Chang Gung Memorial Hospital. All PCs were diagnosed/confirmed by psychiatrists through face-to-face interviews. Results The PCs predicted serious esophagogastroduodenoscopy grading, higher rates of admission/surgery/intensive care unit stay, increments of systemic/gastrointestinal complications, and poorer 5-year overall survival rates. The poor survival among patients with PCs was highly consistent with their baseline characteristics. Significantly advanced age, more non-PCs, alcoholism, illicit drug abuse, and baseline unhealthy status resulted in statistically higher risks of severe complications and limited recovery. Conclusion PCs changed clinical patterns and had critical roles in the survival outcomes of caustic injury victims. Clinical awareness achieves benefit by limiting injuries in mild cases or allowing emergent interventions in severe cases. Future studies based on worldwide populations are essential for realizing geographic differences.
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Affiliation(s)
- Yu-Jhou Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chien-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Ming-Yao Su
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan.,Board of Directors and Supervisors, Taiwan Association for the Study of Small Intestinal Disease (TASSID), Taoyuan 33305, Taiwan
| | - Hsin-Chih Huang
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Chun-Hsiang Ooyang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hao-Tsai Cheng
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
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Li Y, Langworthy J, Xu L, Cai H, Yang Y, Lu Y, Wallach SL, Friedenberg FK. Nationwide estimate of emergency department visits in the United States related to caustic ingestion. Dis Esophagus 2020; 33:5780187. [PMID: 32129451 DOI: 10.1093/dote/doaa012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Caustic ingestion, whether intentional or unintentional, may result in significant morbidity. Our aim was to provide an estimate of the incidence and outcomes of caustic ingestion among emergency department (ED) visits across the United States. METHODS The Nationwide Emergency Department Sample (NEDS) is part of the family of databases developed for the Healthcare Cost and Utilization Project. We analyzed NEDS for the period 2010-2014. Adults (≥18 years of age) with a diagnosis of caustic ingestion were identified by ICD-9 codes. The weighted frequencies and proportions of caustic ingestion-related ED visits by demographic characteristics and disposition status were examined. A weighted multivariable logistic regression model was performed to examine factors associated with inpatient admission for caustic ingestion-related visits. RESULTS From 2010 to 2014, there were 40,844 weighted adult ED visits related to caustic ingestion among 533.8 million visits (7.65/100,000, 95% CI 7.58/100,000-7.73/100,000), resulting in over $47 million in annual cost. Among ED visits related to caustic ingestion, 28% had comorbid mental and substance use disorders. Local and systemic complications were rare. There was significant regional, gender, and insurance variability in the decision as to perform endoscopy. Males, insured patients, patients domiciled in the Southeast region of the United States, and patients with mental or substance use disorders had significantly higher percentages of receiving endoscopic procedures. Overall, 6,664 (16.27%) visits resulted in admission to the same hospital and 1,063 (2.60%) visits resulted in transfer to another hospital or facility. The risk factors for admission were increasing in age, male gender, local or systemic complications related to caustic ingestion, and comorbid mental and substance use disorders. A total of 161 (0.39%) patients died related to caustic ingestion. CONCLUSION Our results from NEDS provide national estimates on the incidence of caustic ingestions involving adults seen in US EDs. Further studies are needed to examine the standard management of caustic ingestion and investigate the factors causing variability of esophagogastroduodenoscopy performance and caustic ingestion care.
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Affiliation(s)
- Yiting Li
- Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences, Saint Francis Medical Center, Trenton, NJ, USA
| | - James Langworthy
- Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lan Xu
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Haifeng Cai
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingwei Yang
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuanyuan Lu
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sara L Wallach
- Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences, Saint Francis Medical Center, Trenton, NJ, USA
| | - Frank K Friedenberg
- Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Rasbach E, Schölch S, Reissfelder C, Rahbari NN. Successful treatment of gastric necrosis after ingestion of hydrochloric acid: a two-stage minimally invasive surgical procedure. BMJ Case Rep 2019; 12:12/10/e231879. [PMID: 31653635 DOI: 10.1136/bcr-2019-231879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Caustic ingestion may cause devastating injuries of the upper gastrointestinal tract and the respiratory system. We report here the successful treatment of a 37-year-old patient who ingested hydrochloric acid (100 mL; 24%) in suicidal intention. An oesophagogastroduodenoscopy revealed extensive necrosis of the gastric mucosa. A diagnostic laparoscopy was performed and confirmed the suspected transmural necrosis which resulted in a discontinuous laparoscopic gastrectomy. During the next days, the oesophageal stump was monitored through frequent oesophagoscopies and showed a good recovery. Thus, it was possible to restore continuity as early as by the sixth postoperative day performing a roux-en-y oesophagojejunostomy using the da Vinci Xi surgical robot. The patient underwent all procedures without any surgical complications and was discharged almost 1 month after initial presentation in good general condition.
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Affiliation(s)
- Erik Rasbach
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Schölch
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. [PMID: 31164915 PMCID: PMC6544956 DOI: 10.1186/s13017-019-0245-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Michael D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Stefano Siboni
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Carlo Galdino Riva
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Davide Ferrari
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Ari Leppäniemi
- Department of Emergency Surgery, University Hospital Meilahti Abdominal Center, Helsinki, Finland
| | | | - Pierre Yves Brichon
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gustavo Pereira Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Gil Frey
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Nelson Adami Andreollo
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | | | | | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | - Walter Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Helene Corte
- Department of Surgery, Saint Louis Hospital, Paris, France
| | - Imtaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Pierre Cattan
- Department of Surgery, Saint Louis Hospital, Paris, France
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
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17
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Mahawongkajit P, Tomtitchong P, Boochangkool N, Limpavitayaporn P, Kanlerd A, Mingmalairak C, Awsakulsutthi S, Havanond C. Risk Factors for Esophageal Stricture in Grade 2b and 3a Corrosive Esophageal Injuries. J Gastrointest Surg 2018; 22:1659-1664. [PMID: 29855871 DOI: 10.1007/s11605-018-3822-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Publications document the risk of developing esophageal stricture as a sequential complication of esophageal injury grades 2b and 3a. Although there are studies describing the risk factors of post-corrosive stricture, there is limited literature on these factors. The aim of this study was to evaluate the different factors with post-corrosive esophageal stricture and non-stricture groups in endoscopic grades 2b and 3a of corrosive esophageal injuries. METHODS Data were retrospectively analyzed in the patients with esophageal injury grades 2b and 3a between January 2011 and December 2017. RESULTS One hundred ninety-six corrosive ingestion patients were admitted with 32 patients (15.8%) in grade 2b and 12 patients (6.1%) in grade 3a and stricture was developed in 19 patients (61.3%) with grade 2b and in 10 patients (83.3%) with grade 3a. The patients' height of the non-stricture group was greater than that of stricture groups (2b stricture group, 1.58 ± 0.08 m; 2b non-stricture group, 1.66 ± 0.07 m; p < 0.004; 3a stricture group, 1.52 ± 0.09 m; 3a non-stricture group, 1.71 ± 0.02 m; p < 0.001). Omeprazole was more commonly used in the non-stricture than stricture group (26.3% in the 2b stricture group, 69.2% in the 2b non-stricture group, p = 0.017; 50% in the 3a stricture group, 100% in the 3a non-stricture group, 1.71 ± 0.02 m, p = 0.015). CONCLUSIONS The height of patients may help to predict the risks and the prescription of omeprazole may help to minimize the risks of 2b and 3a post-corrosive esophageal stricture.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand.
| | - Prakitpunthu Tomtitchong
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Nuttorn Boochangkool
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Palin Limpavitayaporn
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Surajit Awsakulsutthi
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
| | - Chittinad Havanond
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95 Moo 8, Paholyothin Road, Amphur Klongluang, Rangsit, Pathumthani, 12120, Thailand
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18
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Devinck F, Deveaux C, Bennis Y, Deken-Delannoy V, Jeanne M, Martinot-Duquennoy V, Guerreschi P, Pasquesoone L. [Deep alkali burns: Evaluation of a two-step surgical strategy]. ANN CHIR PLAST ESTH 2018; 63:191-196. [PMID: 29653673 DOI: 10.1016/j.anplas.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/16/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. RESULTS Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). CONCLUSION Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure.
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Affiliation(s)
- F Devinck
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France.
| | - C Deveaux
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - Y Bennis
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - V Deken-Delannoy
- EA 2694-santé publique : épidémiologie et qualité des soins, CHU de Lille, université de Lille, 59000 Lille, France
| | - M Jeanne
- Pôle d'anesthésie réanimation, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - V Martinot-Duquennoy
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
| | - L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlures, hôpital R. Salengro, CHU de Lille, 59000 Lille, France
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19
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The Surgical Strategy in Massive Corrosive Injury in Digestive Tract: Is the Extensive Surgery Appropriate? World J Surg 2018; 42:2028-2035. [DOI: 10.1007/s00268-017-4451-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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20
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Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture. World J Surg 2017; 42:211-217. [DOI: 10.1007/s00268-017-4167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France.
| | - Luigi Bonavina
- University of Milan Medical School, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael D Kelly
- Acute Surgical Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Emile Sarfati
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
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22
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Oral Chemical Burns Reported to the Poisons Information Centre in Erfurt, Germany, from 1997 to 2014. J Burn Care Res 2017; 38:e913-e922. [PMID: 28319530 DOI: 10.1097/bcr.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Devastating oral burns often followed by lifelong complications can result from ingestion of caustic substances. However, although being one of the most challenging situations in clinical practice, literature data on the epidemiology of oral burns are still scarce. Retrospective analysis of all cases of oral burns after ingestion of corrosive substances reported to the Poisons Information Centre in Erfurt, Germany, from 1997 to 2014 was performed. In total, 482 calls because of oral burns were registered, with no change in the numbers of cases during the years. In the majority of the instances (47%), toddlers were affected, followed by middle-aged adults (33%). In both age groups, the male sex prevailed. Ingestion of corrosive substances with babies, schoolchildren, adolescents, and elderly were much less frequent. In most cases (78%), the injury occurred accidentally and only in 5% of the instances in suicidal intent; 85% of the suicidal attempts were committed by middle-aged adults and 15% by elderly. Main agents involved in oral burns were cleansing agents (37%), remedies (12%), disinfectants (7%), acids or bases (6%), technical fluids (6%), cosmetics (5%), and foods (5%). Mostly, the calls came from emergency department doctors (58%), in 19% laymen were calling from home, and in 18% the calls came from a doctor's office. Most of the injuries occurred accidentally, in the domestic setting and in toddlers, and would have been preventable. Thus, a more comprehensive education of the population, especially of parents, regarding the dangers arising from household chemicals is still needed.
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The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent. World J Surg 2017; 40:1638-44. [PMID: 26920407 DOI: 10.1007/s00268-016-3466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The mechanisms of damage to the gastrointestinal tract after caustic ingestion are conditioned by the nature of the ingested agent. Whether the nature of the ingested agent has a direct influence on patient outcomes is unknown. METHODS From January 2013 to April 2015, 144 patients underwent emergency management for caustic injuries at the Saint Louis Hospital in Paris. There were 51 men (51 %) and the median age was 44 years [39, 48]. The ingested agents were soda-based strong alkali in 85 patients (59 %), strong acids in 36 patients (25 %), and bleach in 23 patients (16 %). Emergency and long-term outcomes were compared according to the nature of the ingested agent. RESULTS Four patients died (3 %) and 40 patients (28 %) experienced complications. After bleach ingestion, emergency morbidity and mortality were nil, no patient required esophageal reconstruction, and functional outcome was successful in all patients. Acids were more likely to induce transmural gastric (31 vs. 13 %, p =0.042) and duodenal (9 vs. 0 %, p = 0.04) necrosis than strong alkalis, but rates of transmural esophageal necrosis were similar (14 vs. 12 %, p = 0.98). No significant differences were recorded between emergency mortality (9 vs. 1 %, p = 0.15), morbidity (33 vs. 33 %, p = 0.92), the need for esophageal reconstruction (25 vs. 20 %, p = 0.88), and functional success rates (76 vs. 84 %, p = 0.31) after acid and alkali ingestion, respectively. CONCLUSION Bleach causes mild gastrointestinal injuries, while the ingestion of strong acids and alkalis may result in severe complications and death. Acids cause more severe damage to the stomach but similar damage to the esophagus when compared to alkalis.
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Bird J, Kumar S, Paul C, Ramsden J. Controversies in the management of caustic ingestion injury: an evidence-based review. Clin Otolaryngol 2017; 42:701-708. [DOI: 10.1111/coa.12819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 01/19/2023]
Affiliation(s)
- J.H. Bird
- ENT Department; John Radcliffe Hospital; University of Oxford; Oxford UK
| | - S. Kumar
- ENT Department; John Radcliffe Hospital; University of Oxford; Oxford UK
| | - C. Paul
- ENT Department; John Radcliffe Hospital; University of Oxford; Oxford UK
| | - J.D. Ramsden
- ENT Department; John Radcliffe Hospital; University of Oxford; Oxford UK
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Lepore A, D'Antini D, Raimondo P, Mirabella L, Pennisi L, Carrillo G, Cotoia A, Dambrosio M, Cinnella G. Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid. Int Med Case Rep J 2016; 9:353-356. [PMID: 27853393 PMCID: PMC5104299 DOI: 10.2147/imcrj.s119638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy.
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Affiliation(s)
- Anna Lepore
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Davide D'Antini
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Pasquale Raimondo
- Department of Anesthesia and Intensive Care, "Santa Maria" Hospital, Via De Ferrariis, Bari, Italy
| | - Lucia Mirabella
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Leonardo Pennisi
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Giuseppe Carrillo
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Antonella Cotoia
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Michele Dambrosio
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Viale Pinto, Foggia
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Abstract
OBJECTIVE The aim of this study was to describe the management and outcome of tracheobronchial necrosis (TBN) after caustic ingestion. BACKGROUND Emergency pulmonary patch repair has been reported to be lifesaving in patients with caustic TBN. METHODS Patients who underwent management of caustic TBN between 1989 and 2013, were included. TBN was defined as early if present on admission and late if occurring thereafter. Operative outcomes, long-term survival, and functional outcomes were compared with those of 269 patients without TBN who underwent esophagectomy for caustic injuries. RESULTS Twenty patients were included (10 men; median age = 39 years). Early TBN was detected in 14 patients, and late TBN occurred in 7 patients, 8 days (range:: 6-10 days) after admission. TBN involved the left bronchus (n = 17; 85%), the carina (n = 10; 50%), the supracarinal trachea (n = 9; 45%), the right bronchus (n = 4; 20%), and the cervical trachea (n = 3; 15%). Seventeen patients underwent esophagogastrectomy, 2 underwent esophagectomy, and in 1 patient, resection was eventually abandoned. Pulmonary patch repair was performed in 16 patients (80%). Nine patients (45%) died and morbidity was 100%. In univariate analysis, late TBN (P = 0.017) and acid ingestion (P = 0.002) were predictors of mortality. All survivors underwent restoring colopharyngoplasty. Five-year survival (28%) and functional success (25%) rates were significantly impaired when compared with esophagectomy patients without TBN. CONCLUSIONS TBN is one of the most devastating complications of caustic ingestion. Pulmonary patch repair is technically simple and can be lifesaving in this difficult situation.
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Kluger Y, Ishay OB, Sartelli M, Katz A, Ansaloni L, Gomez CA, Biffl W, Catena F, Fraga GP, Di Saverio S, Goran A, Ghnnam W, Kashuk J, Leppäniemi A, Marwah S, Moore EE, Bala M, Massalou D, Mircea C, Bonavina L. Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg 2015; 10:48. [PMID: 26478740 PMCID: PMC4609064 DOI: 10.1186/s13017-015-0043-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.
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Affiliation(s)
- Yoram Kluger
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | - Ofir Ben Ishay
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Amit Katz
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Carlos Augusto Gomez
- />Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Universidade Federal de Juiz de Fora (UFJF), Minas Gerais Jiiz de Fora, Brazil
| | - Walter Biffl
- />Department of Surgery, University of Florida, Gainesville, Florida USA
| | | | - Gustavo P. Fraga
- />Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Jiiz de Fora, Brazil
| | | | - Augustin Goran
- />Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - Wagih Ghnnam
- />Mansoura Faculty of Medicine, Mansoura University Egypt, Mansoura, Egypt
| | - Jeffry Kashuk
- />Assia Medical Group, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Sanjay Marwah
- />Department of Surgery, Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Ernest E. Moore
- />Department of Surgery, Denver Health Medical Center, Denver, USA
| | - Miklosh Bala
- />Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Damien Massalou
- />Hôpital St Roch 5, Université Nice Sophia-Antipolis, Nice, France
| | - Chirica Mircea
- />Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Université Paris, Paris, France
| | - Luigi Bonavina
- />Policlinico San Donato, University of Milan School of Medicine, Milan, Italy
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Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, Simic A, Ansaloni L, Catena F, Fraga GP, Locatelli C, Chiara O, Kashuk J, Coccolini F, Macchitella Y, Mutignani M, Cutrone C, Poli MD, Valetti T, Asti E, Kelly M, Pesko P. Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg 2015; 10:44. [PMID: 26413146 PMCID: PMC4583744 DOI: 10.1186/s13017-015-0039-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/15/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. PURPOSE OF THE STUDY The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. METHODS An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). RESULTS One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. CONCLUSIONS The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.
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Affiliation(s)
- Luigi Bonavina
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Mircea Chirica
- />Department of Digestive Surgery, Saint-Louis Hospital, Paris, France
| | - Ognjan Skrobic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Yoram Kluger
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Aleksander Simic
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- />Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Gustavo P. Fraga
- />Department of Surgery, University of Campinas, Campinas, Brasil
| | - Carlo Locatelli
- />Institute of Toxicology, University of Pavia, Pavia, Italy
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem Rehovot, Israel
| | | | - Yuri Macchitella
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | | | - Cesare Cutrone
- />Department of Otolaryngology, Azienda Ospedaliera, Padova, Italy
| | - Marco Dei Poli
- />Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tino Valetti
- />Department of Anesthesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Asti
- />Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza Malan 1, 20097 San Donato Milanese (Milano), Italy
| | - Michael Kelly
- />Department of Surgery, Wagga Wagga Hospital, Wagga Wagga, Australia
| | - Predrag Pesko
- />Department of Surgery, University of Belgrade, Belgrade, Serbia
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Di Saverio S, Biscardi A, Piccinini A, Mandrioli M, Tugnoli G. Different possible surgical managements of caustic ingestion: diagnostic laparoscopy for Zargar's grade 3a lesions and a new technique of "Duodenal Damage Control" with "4-tubes ostomy" and duodenal wash-out as an option for extensive 3b lesions in unstable patients. Updates Surg 2015; 67:313-20. [PMID: 26141256 DOI: 10.1007/s13304-015-0313-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/15/2015] [Indexed: 12/26/2022]
Abstract
In the present study, we have described two possible approaches in the management of caustic injuries. Diagnostic emergency laparoscopy can be used for exploration in case of stable patients with Zargar's 3a gastric lesions and equivocal peritoneal signs. On the other hand, in case of patients with Zargar's 3b gastric lesions with perforation, diffuse peritonitis and hemodynamic instability, a new possible technique is described as an option to be used in such extensive caustic injuries: duodenal damage control with "4-tubes ostomy" for duodenal and jejunal wash-out of the caustic agent. The aim of this simple technique is to wash-out the caustic agent from the duodenum when the duodenum and Treitz are not yet gangrenous/perforated, as well as to avoid duodenal primary closure and jejuno-jejunal anastomosis over damaged tissues.
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Affiliation(s)
- Salomone Di Saverio
- Trauma Surgery Unit, Maggiore Hospital Trauma Center, Maggiore Hospital CA Pizzardi, L.go Nigrisoli 2, Bologna Local Health District, Bologna, Italy,
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Dinis-Oliveira RJ, Carvalho F, Moreira R, Proença JB, Santos A, Duarte JA, Bastos MDL, Magalhães T. Clinical and forensic signs related to chemical burns: a mechanistic approach. Burns 2015; 41:658-679. [PMID: 25280586 DOI: 10.1016/j.burns.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 12/14/2022]
Abstract
This manuscript highlights and critically analyses clinical and forensic signs related to chemical burns. Signs that may lead to suspicion of a particular chemical are thoroughly discussed regarding its underlying mechanisms. Burns due to sulfuric, hydrofluoric, nitric, hydrochloric (muriatic) and acetic (including derivatives) acids, hydrogen sulphide, sodium (caustic soda) and calcium (cement) hydroxides, paraquat, burns after inflation and rupture of airbags, povidone-iodine, chlorhexidine/alcohol (in preterm infants), laxatives, and vesicants (warfare agents), will be reviewed since these are the most common agents found in daily practice, for which relevant and timed information may be helpful in formulating an emergency treatment protocols and toxicological analysis.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North (ISCS-N), CESPU, CRL, Gandra, Portugal; REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal; Center of Forensic Sciences (CENCIFOR), Portugal; CBMA - Centre of Molecular and Environmental Biology, Department of Biology, University of Minho, Braga, Portugal.
| | - Félix Carvalho
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Roxana Moreira
- IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North (ISCS-N), CESPU, CRL, Gandra, Portugal; CBMA - Centre of Molecular and Environmental Biology, Department of Biology, University of Minho, Braga, Portugal
| | - Jorge Brandão Proença
- IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North (ISCS-N), CESPU, CRL, Gandra, Portugal
| | - Agostinho Santos
- Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Center of Forensic Sciences (CENCIFOR), Portugal; National Institute of Legal Medicine and Forensic Sciences, North Branch, I.P., Portugal
| | | | - Maria de Lourdes Bastos
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Teresa Magalhães
- Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Center of Forensic Sciences (CENCIFOR), Portugal; National Institute of Legal Medicine and Forensic Sciences, North Branch, I.P., Portugal
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Chirica M, Resche-Rigon M, Pariente B, Fieux F, Sabatier F, Loiseaux F, Munoz-Bongrand N, Gornet JM, Brette MD, Sarfati E, Azoulay E, Zagdanski AM, Cattan P. Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy. Surg Endosc 2014; 29:1452-61. [PMID: 25159655 DOI: 10.1007/s00464-014-3823-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/13/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophagectomy is the standard of care for high-grade corrosive esophageal necrosis as assessed endoscopically. However, the inaccuracy of endoscopy in determining the depth of intramural necrosis may lead to unnecessary esophageal resection, with devastating consequences. Our aim was to evaluate the use of computed tomography (CT) for the emergency diagnostic workup of endoscopic high-grade corrosive esophageal necrosis. METHODS In a before (2000-2007)/after (2007-2012) study of patients with grade 3b endoscopic esophageal necrosis, we compared outcomes after routine emergency esophagectomy versus selection for emergency esophagectomy based on CT evidence of transmural necrosis, defined as at least two of the following: esophageal-wall blurring, periesophageal-fat blurring, and the absence of esophageal-wall enhancement. Survival estimated using the Kaplan-Meier method was the primary outcome. RESULTS Compared to the routine-esophagectomy group (n = 125), the CT group (n = 72) had better overall survival in the crude analysis (hazard ratio [HR], 0.43; 95 % confidence interval [95 %CI], 0.21-0.85; P = 0.015) and in the analysis matched on gender, age, and ingested agent (HR, 0.36; 95 %CI, 0.16-0.79; P = 0.011). No deaths occurred among patients managed without emergency esophagectomy based on CT findings, and one-third of CT-group patients had their functioning native esophagus at last follow-up. Self-sufficiency for eating and breathing was more common (84 % vs. 65 %; relative risk [RR], 1.27; 95 %CI, 1.04-1.55; P = 0.016) and repeat suicide less common (4 % vs. 15 %; RR, 0.27; 95 %CI, 0.09-0.82; P = 0.019) in the CT group. CONCLUSION The decision to perform emergency esophagectomy for endoscopic high-grade corrosive esophageal injury should rely on CT findings.
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Affiliation(s)
- Mircea Chirica
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Université Paris 7 Diderot, Paris, France,
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Elmas O, Cevik M, Demir T, Ketani MA. Effect of oral tamoxifen on the healing of corrosive oesophageal burns in an experimental rat model. Interact Cardiovasc Thorac Surg 2014; 19:351-6. [DOI: 10.1093/icvts/ivu185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Onur Elmas
- Department of Physiology, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Muazzez Cevik
- Department of Pediatric Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Tuncer Demir
- Department of Physiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Muzaffer A. Ketani
- Department of Histology and Embryology, Faculty of Veterinary Medicine, Dicle University, Diyarbakır, Turkey
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The role of free flap reconstruction in paediatric caustic burns. Br J Oral Maxillofac Surg 2013; 51:563-4. [DOI: 10.1016/j.bjoms.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 01/07/2013] [Indexed: 11/21/2022]
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Chirica M, Kraemer A, Petrascu E, Vuarnesson H, Pariente B, Halimi B, Munoz-Bongrand N, Sarfati E, Cattan P. Esophagojejunostomy after total gastrectomy for caustic injuries. Dis Esophagus 2013; 27:122-7. [PMID: 23621347 DOI: 10.1111/dote.12079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of the study was to compare outcomes of emergency esophagogastrectomy (EGT) and total gastrectomy with immediate esophagojejunostomy (EJ) in patients with full-thickness caustic necrosis of the stomach and mild esophageal injuries. After caustic ingestion, optimal management of the esophageal remnant following removal of the necrotic stomach remains a matter of debate. Between 1987 and 2012, 26 patients (men 38%, median age 44 years) with isolated transmural gastric necrosis underwent EGT (n = 14) or EJ (n = 12). Early and long-term outcomes of both groups were compared. The groups were similar regarding age (P = 0.66), gender (0.24), and severity of esophageal involvement. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Emergency morbidity (67% vs. 64%, P = 0.80), mortality (17% vs. 7%, P = 0.58), and reoperation rates (25% vs.14%, P = 0.63) were similar after EJ and EGT. One patient (8%) experienced EJ leakage. One patient in the EJ group and 13 patients in the EGT group underwent esophageal reconstruction (P < 0.0001). Aggregate in hospital length of stay was significantly longer in patients who underwent EGT (median 83 [33-201] vs. 36 [10-82] days, P = 0.001). Functional success after EJ and EGT was similar (90% vs.69%, P = 0.34). Immediate EJ can be safely performed after total gastrectomy for caustic injuries and reduces the need of further esophageal reconstruction.
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Affiliation(s)
- M Chirica
- Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Paris, France
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Abstract
BACKGROUND Surgery is the criterion standard for the treatment of severe burns and of late sequels after ingestion of corrosive agents, but long-term outcome is unknown. METHODS Patients who underwent surgery between 1987 and 2006, for the treatment of severe caustic burns (group I, n = 268) or of late sequels (group II, n = 79) were included in the study. Survival and functional outcomes were analyzed. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. To compare the observed mortality with the expected mortality in the general population, a standardized mortality ratio (SMR) was used. RESULTS Overall Kaplan-Meyer survival at 1, 5, 10, and 20 years of patients in group I was 76.4%, 63.6%, 53.9%, and 44.1%, respectively. On multivariate analysis, advanced age (P = 0.0021), extended resection (P = 0.0009), emergency esophagectomy (P = 0.013), and tracheobronchial injuries (P = 0.0011) were independent negative predictors of survival. The SMR of patients in group I was increased to 21.5 when compared to the general French population. Functional success was recorded in 147 (56%) patients in group I. Advanced age (P = 0.012), extended resection (P = 0.012), and emergency tracheotomy (P = 0.02) were independent predictors for failure. After esophageal reconstruction, patients in group II fared better than patients in group I in terms of survival (P = 0.0006) and functional success (P < 0.0001). Still, the SMR of patients in group II increased to 3.67. CONCLUSIONS The need to perform surgery for caustic injuries has a persistent long-term negative impact on survival and functional outcome.
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Cabral C, Chirica M, de Chaisemartin C, Gornet JM, Munoz-Bongrand N, Halimi B, Cattan P, Sarfati E. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc 2011; 26:214-21. [PMID: 21858575 DOI: 10.1007/s00464-011-1857-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 07/04/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Both observational and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper gastrointestinal tract (UGT) but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic UGT injuries in adult patients treated with a surgically aggressive, endoscopy-based therapeutic protocol over a 6-year period. PATIENTS AND METHODS Between January 2002 and December 2007, 315 patients (138 men, mean age = 40 ± 15.5 years) were referred for corrosive UGT injuries. Emergency endoscopy was performed in all patients at admission. Patients with mild injuries (grades I-IIIa) were offered nonoperative management, whereas emergency surgery was performed for severe injuries (grades IIIb and IV). Esophageal reconstruction was offered to psychologically stable patients after emergency esophageal resection and for esophageal strictures that failed endoscopic dilation. Functional failure was defined as the impossibility to remove the jejunostomy or/and the tracheotomy tube. RESULTS At endoscopy 73 (23%) patients did not have UGT injuries, 158 (50%) patients had mild injuries eligible for nonoperative management and 84 (27%) patients had severe injuries. Nonoperative management was successful in 93% of patients with mild injuries. Surgical exploration was eventually performed in 88 (28%) patients and resection was undertaken in 76 of them. Emergency mortality was 7% and all fatalities were patients with initial severe injuries. After a median follow-up of 6 days (range = 1 day-8.5 years), functional failure was recorded in 9 (3%) patients, all of whom had initial severe injuries. CONCLUSION Emergency endoscopic grading of caustic injuries is the main factor that conditions outcome after caustic ingestion.
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Affiliation(s)
- Carmen Cabral
- Service de Chirurgie Générale, Digestive et Endocrinienne, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475, Paris Cedex 10, France
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Ananthakrishnan N, Parthasarathy G, Kate V. Acute corrosive injuries of the stomach: a single unit experience of thirty years. ISRN GASTROENTEROLOGY 2010; 2011:914013. [PMID: 21991535 PMCID: PMC3168572 DOI: 10.5402/2011/914013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 10/21/2010] [Indexed: 12/17/2022]
Abstract
Introduction. The spectrum of gastric injury due to corrosives can vary. This paper presents a single center experience of over 30 years of corrosive gastric injuries of 39 patients with acute gastric injuries from 1977 till 2006. Patients and Methods. Two thirds of the patients in the acute injury group had a concomitant esophageal injury. The age of the patients ranged from 4 years to 65 years with a slight preponderance of males. (M : F ratio 22 : 17). Results. 36 out of 39 acute gastric injuries were due to ingestion of acids. Three patients had history of caustic soda ingestion. Oral hyperemia or ulcers of varying extent were seen in all patients. The stomach showed hyperemia in 10, extensive ulcers in 13, and mucosal necrosis in 10 patients. Fifteen patients (15/39, 38.5%) were managed conservatively. Twenty four patients (24/39, 61.5%) underwent laparotomy: one for frank peritonitis, 10 for gastric mucosal necrosis, and 13 others for extensive gastric ulcerations. Overall the mortality rate was 29.6 %. Conclusion. Although the mortality and morbidity of acute corrosive gastric injuries is high, the key to improve the survival is early identification of perforation, maintenance of nutrition and control of sepsis.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
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Ananthakrishnan N, Parthasarathy G, Kate V. Chronic corrosive injuries of the stomach-a single unit experience of 109 patients over thirty years. World J Surg 2010; 34:758-64. [PMID: 20098987 DOI: 10.1007/s00268-010-0393-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Corrosive gastric injuries are not uncommon in developing countries because acids, which are more frequently associated with gastric injury, constitute the major type of offending chemical. The spectrum of gastric injury may vary from acute to varying types of chronic gastric involvement. METHODS The 109 consecutive patients with chronic corrosive gastric injuries treated in a single tertiary care superspecialty institute over a period of 30 years were reviewed with special reference to presentation and problems in management. RESULTS Acids contributed to 82.6% of chronic injuries. Chronic gastric injuries were usually one of five types in these patients. The majority had prepyloric strictures (83.5%). The remaining strictures were antral (4.6%), body (3.7%), pyloroduodenal (2.7%), or diffuse (5.5%).Twenty-one (22.8%) patients had a delayed gastric outlet obstruction, and18 patients had a concomitant esophageal stricture requiring a bypass. Most of the patients with chronic injury underwent surgical correction with Billroth I gastrectomy (77.1%), loop gastrojejunostomy (11.0%), and distal gastrectomy with Polya reconstruction (3.7%). Other procedures performed were pyloroplasty in 1 patient and colonic conduit jejunal anastomosis in 6 patients. One patient (1%) died in the postoperative period. CONCLUSIONS The management of chronic corrosive gastric injury depends on the type of gastric involvement, the presence of co-existent esophageal stricture, and the general condition of the patient. A limited resection of the affected stomach is the ideal procedure for the common type of gastric injury. In patients whose general condition prohibits major resection or where the stricture extends to the antrum the best treatment is a loop gastroenterostomy. Type III, IV, V strictures require individualized treatment. Delayed gastric outlet obstruction affects the treatment plan of combined gastric and esophageal injuries.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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Contini S, Garatti M, Swarray-Deen A, Depetris N, Cecchini S, Scarpignato C. Corrosive oesophageal strictures in children: outcomes after timely or delayed dilatation. Dig Liver Dis 2009; 41:263-268. [PMID: 18801710 DOI: 10.1016/j.dld.2008.07.319] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/23/2008] [Accepted: 07/25/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Among benign oesophageal lesions, caustic strictures are the most difficult to dilate. In low-income countries, children suffering caustic oesophageal injury are frequently referred to the hospitals late, sometimes weeks after ingestion. Therefore, dilatation may be performed late and in highly fibrotic strictures. Reports about endoscopic and clinical outcome of such delayed dilatations are scanty. The aim of this study was to evaluate the safety and efficacy of late caustic stricture dilatations in children, comparing it with the results of timely dilatations, both performed at the Hospital of the Italian Non-Governmental Organization "Emergency" at Goderich, Sierra Leone. PATIENTS AND METHODS From December 2005 to May 2007, 78 children (<15 years) complaining alkaline caustic ingestion were submitted to oesophageal dilatation, mainly (97%) using Savary dilators. Two groups were identified: children (group 1) with a late treatment (>6 weeks, 37+/-12 weeks), having arrived to the hospital late after ingestion, and children (group 2) dilated timely, i.e. at <6 weeks (4+/-1.4 weeks) after injury. RESULTS Strictures were severe in all patients. Twenty-five children were dilated late after injury (6.4 dilatations/patient) with a follow-up of 11+/-2.5 months. A successful clinical outcome was observed in 91.6%. Four perforations (2.6% procedure-related) and one death (4.0%) were observed. Strictures recurred once in 72% of patients, twice in 31.8%. Thirty-one children were dilated timely (4.5 dilatations/patient) with a follow-up of 10+/-2.1 months and a clinical success rate of 96.7%. Procedure-related perforation rate was 0.7% with one death (3.2%). Stricture recurred once in 30% and twice in 3.3%. CONCLUSIONS Delayed dilatation of caustic oesophageal strictures in children carries a higher risk of perforation and a higher recurrence rate.
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Affiliation(s)
- S Contini
- Department of Surgical Sciences, School of Medicine & Dentistry, University of Parma, Italy.
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Keh SM, Onyekwelu N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol 2006; 12:5223-8. [PMID: 16937538 PMCID: PMC4088025 DOI: 10.3748/wjg.v12.i32.5223] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed and developing countries, corrosive injury to the gastrointestinal system as a consequence of either accidental ingestion or as a result of self-harm has become a less common phenomenon compared to decades ago. This could partly be attributed to the tighter legislation imposed by the government in these countries on detergents and other corrosive products and general public awareness. Most busy upper gastrointestinal surgical units in these countries, especially in the developed countries will only encounter a small number of cases per year. Up to date knowledge on the best management approach is lacking. In this article, we present our experience of two contrasting cases of corrosive injury to the upper gastrointestinal tract in our thoracic unit in the last 2 years and an up-to-date Medline literature search has been carried out to highlight the areas of controversies in the management of corrosive injuries of the upper gastrointestinal tract. We concluded that the main principle in managing such patients requires a good understanding of the pathophysiology of corrosive injury in order to plan both acute and future management. Each patient must be evaluated individually as the clinical picture varies widely. Signs and symptoms alone are an unreliable guide to injury.
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Affiliation(s)
- Siew Min Keh
- The Royal National Nose, Throat and Ear Hospital, London, WC1X 8DA, United Kingdom.
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Ryan F, Witherow H, Mirza J, Ayliffe P. The oral implications of caustic soda ingestion in children. ACTA ACUST UNITED AC 2006; 101:29-34. [PMID: 16360605 DOI: 10.1016/j.tripleo.2005.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2005] [Revised: 04/25/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
The morbidity related to caustic soda (sodium hydroxide) ingestion is well described in the literature. The majority of publications have concentrated on the effects to the trachea and gastrointestinal tract, with little reference to the oral and peri-oral areas. Accidental ingestion of sodium hydroxide-containing substances is fortunately rare; however the consequences can be devastating. Three cases of children who drank caustic substances are described. Treatment included fitting splints, injecting steroids, local surgical procedures, and the use of dynamic appliances to maintain mouth opening. Despite these interventions, all patients developed severe scarring, resulting in stenosis of the oral musculature and extra-articular ankylosis. There is perhaps a role for further investigation of early use of antiproliferative agents to prevent scarring, more aggressive surgery, and long-term physiotherapy appliance use. These patients require lifelong follow-up.
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Affiliation(s)
- Fiona Ryan
- Oral and Maxillofacial Surgery, Dental and Maxillofacial Department, Great Ormond Street Hospital, London, UK.
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Chiu HM, Lin JT, Huang SP, Chen CH, Yang CS, Wang HP. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc 2004; 60:827-33. [PMID: 15557970 DOI: 10.1016/s0016-5107(04)02031-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury. METHODS Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded. OBSERVATIONS All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff. CONCLUSIONS EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Munoz-Bongrand N, Cattan P, de Chaisemartin C, Bothereau H, Honigman I, Sarfati E. [Extensive digestive caustic burns: what are the limits for resection? A series of 12 patients]. ANNALES DE CHIRURGIE 2003; 128:373-8. [PMID: 12943833 DOI: 10.1016/s0003-3944(03)00113-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM OF THE STUDY To report the results of oesogastric resections extended to surrounding organs following caustic ingestion, and to precise indications for resection and results of reconstruction. PATIENTS AND METHODS From 1988 to 2001, 12 patients underwent oesophago-gastrectomy, extended to duodenum and pancreatic head (n = 6), jejunum (n = 4), colon (n = 2), spleen (n = 2) or pancreatic body (n = 1). Early morbidity and mortality, specificities of reconstruction, and quality of oral feeding were assessed retrospectively. RESULTS Mean intensive care unit stay was 50 days (range: 16-152 days). All patients developed complications. Six patients were reoperated for secondary extension of caustic burns, mainly to colon (n = 4), small bowel (n = 2) and pancreas (n = 2). Three patients died on postoperative days 17, 20, and 130. Secondarily, eight patients (75%) underwent a substernal right ileocoloplasty. Six patients (50%) survived initial resection, and esophageal reconstruction. After a mean follow-up of 35 months (range: 7-87 months), four patients (33%) eat normally. CONCLUSIONS After caustic burn, oesogastric resections extended to surrounding organs are associated with high morbidity and mortality. However, return of normal oral feeding can be expected in 33% of cases. Secondary extension of caustic burns to adjacent organs is a common eventuality, and may lead to prompt reintervention. Massive injury to small bowel or colon may compromise digestive function or secondary esophageal reconstruction, and thus may be the reasonable limit for resection.
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Affiliation(s)
- N Munoz-Bongrand
- Service de chirurgie digestive et endocrinienne, hôpital Saint-Louis, AP-HP, Université Paris VII, France
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Pruvot FR, Brami F, Saulnier F, Gambiez L, Roumilhac D, Chambon JP, Paris JC, Quandalle P. [Gastric conservation in severe caustic lesions of the digestive tract: is it legitimate?]. ANNALES DE CHIRURGIE 2003; 128:11-7. [PMID: 12600323 DOI: 10.1016/s0003-3944(02)00002-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate advantages and drawbacks of a controlled conservative management of patients with severe gastric caustic injuries. METHODS Among 40 patients with severe caustic gastric burns (> IIb), 28 with stade III lesions (mosaic necrosis: n = 10, extensive or circumferential necrosis: n = 18) were managed prospectively from 1990 to 1998. Twenty-two patients had associated stage III oesophageal lesions and 6 had stage III duodenal lesions. All patients were followed up by daily surgical examination. Total gastrectomy with esophageal exclusion or stripping was performed in case of perforation. RESULTS Five immediate and 7 secondary total gastrectomies, two associated esophagectomies and two jejunal resections were performed. Mortality rate was 18% (5/28). Sixteen gastric preservations (60%) were achieved, including 7 complete and 9 partial because of gastric stricture. Eighteen esophagoplasties for oesophageal strictures or after gastrectomy were performed without mortality. CONCLUSION Stage III caustic injuries of the stomach, when they are not immediately life-threatening, do not systematically require total gastrectomy. A strict conservative attitude can be done with significant morbidity and acceptable mortality and significantly raises the numbers of preserved stomach.
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Affiliation(s)
- F R Pruvot
- Service de chirurgie digestive et transplantations, CHU--hôpital Claude-Huriez, avenue Michel-Polonovski 59037 Lille cedex, France.
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Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg 2002. [PMID: 12368682 DOI: 10.1097/00000658-200210000-00016] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the authors' experience with gastric transposition as a method of esophageal replacement in children with congenital or acquired abnormalities of the esophagus. SUMMARY BACKGROUND DATA Esophageal replacement in children is almost always done for benign disease and thus requires a conduit that will last more than 70 years. The organ most commonly used in the past has been colon; however, most series have been fraught with major complications and conduit loss. For these reasons, in 1985 the authors switched from using colon interpositions to gastric transpositions for esophageal replacement in infants and children. METHODS The authors retrospectively reviewed the records of 41 patients with the diagnoses of esophageal atresia (n = 26), corrosive injury (n = 8), leiomyomatosis (n = 5), and refractory gastroesophageal reflux (n = 2) who underwent gastric transposition for esophageal replacement. RESULTS Mean +/- SE age at the time of gastric transposition was 3.3 +/- 0.6 years. All but two transpositions were performed through the posterior mediastinum without mortality or loss of the gastric conduit despite previous surgery on the gastric fundus in 8 (20%), previous esophageal operations in 15 (37%), and previous esophageal perforations in 6 (15%) patients. Complications included esophagogastric anastomotic leak (n = 15, 36%), which uniformly resolved without intervention; stricture formation (n = 20, 49%), all of which no longer require dilation; and feeding intolerance necessitating jejunal feeding (n = 8, 20%) due to delayed gastric emptying (n = 3), feeding aversion related to the underlying anomaly (n = 1), or severe neurological impairment (n = 4). No redo anastomoses were required. CONCLUSIONS Gastric transposition reestablishes effective gastrointestinal continuity with few complications. Oral feeding and appropriate weight gain are achieved in most children. Therefore, gastric transposition is an appropriate alternative for esophageal replacement in infants and children.
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Hirschl RB, Yardeni D, Oldham K, Sherman N, Siplovich L, Gross E, Udassin R, Cohen Z, Nagar H, Geiger JD, Coran AG. Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg 2002; 236:531-9; discussion 539-41. [PMID: 12368682 PMCID: PMC1422608 DOI: 10.1097/01.sla.0000030752.45065.d1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the authors' experience with gastric transposition as a method of esophageal replacement in children with congenital or acquired abnormalities of the esophagus. SUMMARY BACKGROUND DATA Esophageal replacement in children is almost always done for benign disease and thus requires a conduit that will last more than 70 years. The organ most commonly used in the past has been colon; however, most series have been fraught with major complications and conduit loss. For these reasons, in 1985 the authors switched from using colon interpositions to gastric transpositions for esophageal replacement in infants and children. METHODS The authors retrospectively reviewed the records of 41 patients with the diagnoses of esophageal atresia (n = 26), corrosive injury (n = 8), leiomyomatosis (n = 5), and refractory gastroesophageal reflux (n = 2) who underwent gastric transposition for esophageal replacement. RESULTS Mean +/- SE age at the time of gastric transposition was 3.3 +/- 0.6 years. All but two transpositions were performed through the posterior mediastinum without mortality or loss of the gastric conduit despite previous surgery on the gastric fundus in 8 (20%), previous esophageal operations in 15 (37%), and previous esophageal perforations in 6 (15%) patients. Complications included esophagogastric anastomotic leak (n = 15, 36%), which uniformly resolved without intervention; stricture formation (n = 20, 49%), all of which no longer require dilation; and feeding intolerance necessitating jejunal feeding (n = 8, 20%) due to delayed gastric emptying (n = 3), feeding aversion related to the underlying anomaly (n = 1), or severe neurological impairment (n = 4). No redo anastomoses were required. CONCLUSIONS Gastric transposition reestablishes effective gastrointestinal continuity with few complications. Oral feeding and appropriate weight gain are achieved in most children. Therefore, gastric transposition is an appropriate alternative for esophageal replacement in infants and children.
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Affiliation(s)
- Ronald B Hirschl
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan 48109-0245, USA.
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