IDDF2018-ABS-0049 Management of caustic consumption injuries – a multidisciplinary effort for a successful outcome

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Abstract

Background

Ingestion of corrosive substances results in severe damage to the upper aero digestive system and is still a major cause of concern in India. Injuries depend on the type of substance, quality, quantity and the intention. Corrosive agents produce extensive damage to the gastrointestinal tract, which may result in death in the acute phase or may result in long-term sequelae. We describe the experience of our department in treating such injuries.

Methods

All corrosive injury patients, acute and late, presented to the Department of Surgical Gastroenterology from Jan 2009 – June 2016, are included in this retrospective study.

Results

Between Jan 2009 – June 2016, 55 patients were admitted with a history of corrosive agent consumption. 23 patients had an only mild mucosal injury and were treated conservatively and required no further intervention.

Results

3 required emergency total gastrectomy with a cervical esophagostomy of whom only one survived.

Results

24 patients underwent repeated esophageal dilatations for strictures. 1 of them had a spontaneous duodenal perforation and succumbed. 17 patients responded very well to the dilatation protocol. 6 patients underwent surgery for complication/failure of endoscopic dilatation.

Results

5 patients presented late with well-established strictures with poor nutrition and underwent a feeding jejunostomy with a reconstructive procedure at a later date.

Results

A total of 11 patients underwent a reconstructive procedure, 7 underwent a colonic pull through, and 4 underwent a Billroth II distal gastrectomy.

Conclusions

Corrosive injury of the upper gastrointestinal tract is a complex condition, requiring an intensive approach and multidisciplinary management. Maintenance of nutrition is essential for a good outcome. The native oesophagus should be salvaged whenever possible. Meticulous intra-operative technique and ensuring good vascular supply of the conduit are the cornerstones of a successful outcome.

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