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Shah J, Jena A, Shweta S, Vaiphei K, Gupta V, Kumar N, Singh AK, Kochhar R. Corrosive induced esophageal and gastric injury: Histopathological evaluation of surgically resected specimens over a decade in a tertiary care center. INDIAN J PATHOL MICR 2024; 67:379-384. [PMID: 38391330 DOI: 10.4103/ijpm.ijpm_764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/09/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Caustic ingestion is associated with long-term sequelae like esophageal stricture, gastric cicatrization, and long-term risk of dysplasia or even carcinoma. However, only a few small studies have explored histopathological aspects of caustic-induced esophageal/gastric injury. MATERIALS AND METHODS We retrospectively evaluated specimens of patients undergoing surgery due to caustic ingestion-related complications from 2008 to 2020. Pathological examination was conducted by two independent gastro-pathologists to evaluate the extent and depth of the caustic injury, presence or absence of tissue necrosis, type and degree of inflammation, or presence of any dysplastic cells. RESULTS A total of 54 patients underwent surgical exploration during the inclusion period and complete details of 39 specimens could be retrieved. The mean age of the included patients was 28.66 ± 9.31 years and 25 (64.1%) were male. The majority of patients (30; 76.9%) had a history of caustic ingestion more than three months before the surgery and the presence of long or refractory stricture was the most common indication for the surgery (20; 51.28%). In the resected specimen, a majority of patients had superficial esophageal or gastric ulcer (90.6%; 60.0%), transmural inflammation (68.8%; 65.6%), transmural fibrosis (62.5%; 34.4%), and hypertrophied muscularis mucosa (78.13%; 53.3%). However, none of the patients had dysplasia in the resected esophageal or gastric specimens. CONCLUSION Caustic ingestion leads to mucosal ulceration, transmural inflammation, and transmural fibrosis which might be the reason for refractory stricture in such patients.
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Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shweta Shweta
- Department of Histopathology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kumar
- Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anupam K Singh
- Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Deniau B, Boulet N, Pétrier M, Mezzarobba M, Coutrot M, Cattan P, Corté H, Dépret F, Lefrant JY, Plaud B, Boudemaghe T. Epidemiologic features and outcomes associated with caustic ingestion among adults admitted in intensive care unit from 2013 to 2019: a French national observational study. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02392-9. [PMID: 38114647 DOI: 10.1007/s00068-023-02392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Caustic ingestion is a potential life-threatening condition associated with high morbidity and mortality. Data on patients admitted to Intensive Care Unit (ICU) for severe caustic ingestion are lacking. We aimed to describing epidemiological features and outcomes of patients admitted to ICU for caustic ingestion in France. METHODS In a retrospective, observational, and multicenter study, data from the national French Programme de Médicalisation des Systèmes d'Informations (PMSI) database were analysed from 2013 to 2019. In-hospital mortality rate (primary outcome) and in-ICU complications (secondary outcomes) were reported and analysed. RESULTS 569 patients (289 males (50.8%), with median age of 49 years [interquartile (26-62)] were admitted in 65 French ICU for severe caustic ingestion. Five hundred and thirteen patients (90%) were admitted for intentional caustic ingestion. The median length of stay in ICU was 14.0 [4.0-31.0] days. In-hospital mortality occurred in 56 patients (9.8%). In multivariate analysis, age and simplified acute physiology score II were associated with in-hospital mortality age of 40-59 years [OR = 15.3 (2.0-115.3)], age of 60-79 years [OR = 23.6 (3.1-182.5)], and age > 80 years [OR = 37.0 (4.2-328.6)] and SAPS 2 score [OR = 1.0018 (1.003-1.033), p < 0.001]. During ICU stay, 423 complications (74%) were reported in 505 patients (89%). Infectious (244 (42.9%)), respiratory (207 (36.4%)), surgical 62 (10.9%), haemorrhagic (64 (11.2%)) and thrombo-embolic and (35 (6.2%)) complications were the most frequently reported during ICU stay. CONCLUSION ICU admission for severe caustic ingestion is associated with 9.8% mortality and 74% complications. Age > 40 years and SAPS 2 score were independently associated with mortality.
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Affiliation(s)
- Benjamin Deniau
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France.
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France.
- Université Paris Cité, Paris, France.
- FHU PROMICE, Paris, France.
| | - Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Melissa Pétrier
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Myriam Mezzarobba
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Maxime Coutrot
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Pierre Cattan
- Université Paris Cité, Paris, France
- Service de Chirurgie Viscérale, Cancérologique Et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Helene Corté
- Service de Chirurgie Viscérale, Cancérologique Et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - François Dépret
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Benoit Plaud
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Thierry Boudemaghe
- Service Information Médicale, Méthodes Et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
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Gupta V, Shah J, Yadav TD, Kumar P, Wig JD, Kochhar R. Emergency surgical intervention in acute corrosive ingestion: single-center experience from India. ANZ J Surg 2023; 93:2864-2869. [PMID: 37350433 DOI: 10.1111/ans.18576] [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: 12/30/2022] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Surgical intervention for acute corrosive injury is often required. It is associated with considerable morbidity and mortality. Sparce data is available on the types and timing of surgery after acute corrosive ingestion and complications associated with the same. METHODS This is a retrospective single-center study from a tertiary care center in India. All patients who underwent surgical exploration after acute corrosive intake between January 2003 and June 2014 were enrolled in the study. Data on patients' presentation, their endoscopic findings, indications of surgery, type of surgery and post-operative follow-up was retrieved. RESULTS Out of 170 patients who presented with acute corrosive ingestion, 24 patients (14.11%) required emergency surgery. The mean interval between ingestion and surgery was 9.92 ± 9.03 days. Presence of peritonitis was the most common indication for surgery (n = 10; 41.7%) followed by mediastinitis (n = 7; 29.2%). A total of 17 resectional and 7 non-resectional procedures were performed. Thirteen (54%) patients succumbed to their illness post-operatively due to multi-organ failure (n = 9), refractory shock (n = 3) or pulmonary thromboembolism (n = 1). Patients with early surgery (≤7 days) after corrosive ingestion had similar mortality compared to patients with late surgery (>7 days) (50% versus 67%; P = 0.30). Of the 11 surviving patients, eight patients (72%) underwent successful reconstructive surgery on follow-up. CONCLUSIONS Emergency surgery after corrosive ingestion carries high morbidity and mortality. However, after the initial stormy acute phase, majority of patients can undergo successful reconstructive surgery on follow-up.
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Affiliation(s)
- Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pradeep Kumar
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jai Dev Wig
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Use of free jejunal flap as a salvage procedure in the management of high corrosive esophageal re-strictures: an institutional experience and review of literature. Langenbecks Arch Surg 2022; 407:2725-2732. [PMID: 35759020 DOI: 10.1007/s00423-022-02595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND High pharyngo-esophageal strictures following corrosive ingestion continue to pose a challenge to the surgeon, particularly in the developing world. With the advancements and increased experience with microsurgical techniques, free jejunal flaps offer a viable reconstruction option in patients with high corrosive strictures with previous failed reconstruction. We review our experience with free jejunal flap in three cases with high pharyngo-esophageal stricture following corrosive ingestion, with previous failed reconstruction. MATERIALS AND METHODS A total of three patients underwent salvage free jejunal flap after failed reconstruction for high pharyngo-esophageal strictures following corrosive acid ingestion. All the three patients developed anastomotic leak and subsequent stricture, two following a pharyngo-gastric anastomosis and one following a pharyngo-colic anastomosis. The strictured segment was bridged using a free jejunal graft with microvascular anastomosis to the lingual artery and common facial vein. All patients were followed-up at regular intervals. RESULTS AND CONCLUSIONS The strictured pharyngeal anastomotic segment was successfully reconstructed with free jejunal flap in all the three patients. Patients were able to take food orally and maintain nutrition without the need of jejunostomy feeding. On long-term follow-up (median: 5 years), there was no recurrence of dysphagia and all the patients had good health-related quality of life.
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Kumar SP, Ahmed Z, M RR, Shetty MG, Rao GV, Subramanyeshwar Rao T, Rebala P. Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Radhakrishna V, Kumar N, Gadgade BD, Vasudev RB, Alladi A. Sequelae of Corrosive Injury in Children: An Observational Study. J Indian Assoc Pediatr Surg 2022; 27:435-440. [PMID: 36238332 PMCID: PMC9552654 DOI: 10.4103/jiaps.jiaps_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/16/2021] [Accepted: 10/16/2021] [Indexed: 11/04/2022] Open
Abstract
Aim This study aims to determine the sequelae of corrosive ingestion in children. Methods A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study. Results A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test). Conclusion The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.
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Affiliation(s)
- Veerabhadra Radhakrishna
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Nitin Kumar
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India,Address for correspondence: Dr. Nitin Kumar, Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India. E-mail:
| | - Bahubali Deepak Gadgade
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Raghunath Bangalore Vasudev
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anand Alladi
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Nayar R, Varshney VK, Goel AD. Outcomes of Gastric Conduit in Corrosive Esophageal Stricture: a Systematic Review and Meta-analysis. J Gastrointest Surg 2022; 26:224-234. [PMID: 34506024 DOI: 10.1007/s11605-021-05124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes, morbidity, and complications associated with it. METHODS MEDLINE, Cochrane Library, and Google Scholar (January 1960 to May 2020) were systematically searched for all studies reporting short- and/or long-term outcomes and complications following the use of a gastric conduit for corrosive esophageal stricture. RESULTS Seven observational studies involving 489 patients (53.2% males, mean age ranging from 22.1 to 41 years) who had ingested a corrosive substance (acid in 74.8%, alkali in 20.7%, and unknown in the rest) were analyzed. Gastric pull-up was performed in 56.03% (274/489) of patients. Median blood loss in the procedure was 187.5 ml with a mean operative duration of 298.75 ± 55.73 min. The overall pooled prevalence rate of anastomotic leak was 14.4% [95% CI (6.2-24.0); p < 0.05, I2 = 67.38], and anastomotic stricture was 27.2% [95% CI (13-42.8); p < 0.001, I2 = 80.11]. Recurrent dysphagia according to pooled prevalence estimates occurred in 14.4% patients [95% CI (5.4-25.1); p < 0.05, I2 = 69.1] and 90-day mortality in 4.8% patients [95% CI (1.5-9.1%); I2 = 31.1, p = 0.202]. The dreaded complication of conduit necrosis had a pooled prevalence of 1.3% [95% CI (0.1-3.4%); I2 = 0, p = 0.734]. CONCLUSION The stomach can be safely used as the conduit of choice in corrosive strictures with an acceptable rate of complications, postoperative morbidity, and mortality.
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Affiliation(s)
- Raghav Nayar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, Jodhpur, 342005, Rajasthan, India.
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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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: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Danardono E. Case Report: POST ESOPHAGECTOMY ESOPHAGEAL RECONSTRUCTION IN ESOPHAGEAL INJURY DUE TO CAUSTIC MATERIALS. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v53i4.7163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The esophageal caustic injury is rare, but it requires precise and complex management. A variety of reconstruction techniques have been done, but despite the increasing volume, the incidence of complications is still relatively high. We reported the experience in our center in handling esophageal reconstruction in patients with caustic esophageal injury that caused oesophageal stricture between 2014-2017. This study used case series method with literature review. The results showed that between 2014-2017, there were 3 patients with caustic esophageal injury. All patients undergoing esophageal reconstruction surgery were included under conditions of malnutrition. Two were caused by HCl and the rest by NaOH. All patients underwent a resection of stricture segment of the esophagus, either using partial or total esophagectomy. Anastomosis leakage occurred in all cases, but improved with conservative treatment. The average length of hospitalization was 27 days. The intraoperative blood loss in patients ranged from 450-700 cc. In conclusion, proper preliminary management can provide approppiate preparation of the patients for definitive or reconstructive surgery, especially to avoid malnutrition. The ideal reconstruction still could not be established, and the rate of postoperative complications was still high. The length of patient hospitalization was also relatively long.
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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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De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther 2017; 8:90-98. [PMID: 28533917 PMCID: PMC5421115 DOI: 10.4292/wjgpt.v8.i2.90] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.
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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: 2.9] [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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15
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Chernyavskiy AA, Lavrov NA. Esophagogastrectomy with simultaneous intestinal repair. Khirurgiia (Mosk) 2016:33-49. [PMID: 27628228 DOI: 10.17116/hirurgia2016833-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to present treatment of patients with gastroesophageal cancer. MATERIAL AND METHODS 41 cases of esophagogastrectomy with simultaneous intestinal repair were analyzed. There were 37 operations for malignancies and 4 operations for benign diseases. Indications for surgery were defined. Abdominocervical access was predominantly used. In 6 patients esophageal repair was finished by high intrapleural anastomosis due to insufficient length of the graft for cervical anastomosis. Surgical technique of esophagogastrectomy was described in detail at all stages. RESULTS AND DISCUSSION Better functional results were achieved in isoperistaltic esophagocoloplasty when graft's aboral end was anastomosed with Roux-segment of jejunum or with vertical bend of duodenum in end-to-side fashion. Mortality rate was 12.2%. CONCLUSION We consider that isoperistaltic repair on left colonic vessels has better functional results.
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Affiliation(s)
- A A Chernyavskiy
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - N A Lavrov
- Nizhny Novgorod State Medical Academy, Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
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Rollin M, Jaulim A, Vaz F, Sandhu G, Wood S, Birchall M, Dawas K. Caustic ingestion injury of the upper aerodigestive tract in adults. Ann R Coll Surg Engl 2015; 97:304-7. [PMID: 26263940 DOI: 10.1308/003588415x14181254789286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Adult ingestion of caustic substances is an unusual but serious surgical problem, with injuries likely to be more extensive than those in the corresponding paediatric population. After initial stabilisation and airway management, clinicians are presented with a complex multisystemic problem, frequently requiring a multidisciplinary approach involving several surgical disciplines and associated therapies. A new multidisciplinary team was convened to discuss complex ingestion injury in adults and established techniques were used to bring forward a proposed treatment algorithm. An algorithm may potentially improve clinical efficacy and risk in the management of these complex patients.
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Affiliation(s)
- M Rollin
- University College London Hospitals NHS Foundation Trust , UK
| | - A Jaulim
- University College London Hospitals NHS Foundation Trust , UK
| | - F Vaz
- University College London Hospitals NHS Foundation Trust , UK
| | - G Sandhu
- Imperial College Healthcare NHS Trust , UK
| | - S Wood
- Imperial College Healthcare NHS Trust , UK
| | - M Birchall
- University College London Hospitals NHS Foundation Trust , UK
| | - K Dawas
- University College London Hospitals NHS Foundation Trust , UK
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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: 52] [Impact Index Per Article: 5.8] [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: 1.0] [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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Gupta V, Kurdia KC, Sharma A, Mishra AK, Yadav TD, Kochhar R. Tracheoesophageal fistula in adults due to corrosive ingestion: challenges in management. Updates Surg 2015; 67:75-81. [DOI: 10.1007/s13304-015-0292-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Javed A, Agarwal AK. Total laparoscopic esophageal bypass using a colonic conduit for corrosive-induced esophageal stricture. Surg Endosc 2013; 27:3726-32. [PMID: 23636519 DOI: 10.1007/s00464-013-2956-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/29/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The colon and the stomach are the most commonly used conduits for esophageal replacement in patients with esophageal strictures resulting from corrosive ingestion. The replacement surgeries have traditionally been performed by an open approach. While laparoscopic replacement surgery using a stomach conduit has been previously reported, a total laparoscopic bypass using a colonic conduit has not been previously described. We herein describe the surgical technique and results of laparoscopic esophageal bypass using a colonic conduit. METHODS Patients with corrosive stricture involving the esophagus with the proximal level at the hypopharynx, or those with concomitant gastric scarring, were selected. The surgery was performed with the patient in a supine position using five abdominal ports and a hockey stick/transverse skin crease neck incision. The main steps include colonic mobilization and assessment of the adequacy of the marginal vascular arcade, creation of a retrosternal tunnel, preparation of the colonic conduit, neck dissection, delivery of the colonic conduit into the neck and cervical pharyngo/esophagocolic anastomosis, and intra-abdominal cologastric and ileocolic anastomosis. RESULTS During the study period, 39 patients with corrosive stricture of the esophagus were managed surgically at our center with either gastric or colonic bypass. Of these, 22 patients underwent an open procedure (12 retrosternal colonic bypasses and 10 retrosternal gastric bypasses) and 17 patients underwent a laparoscopic procedure (13 retrosternal gastric bypasses and 4 retrosternal colonic bypasses). Patients with stricture at the hypopharynx (n = 2) or those in whom the stomach was contracted (n = 2) were considered for a laparoscopic esophagocoloplasty. The average duration of surgery of these latter four patients was 370 (380, 320, 360, and 420) min and the mean estimated blood loss was 100 mL. All patients could be ambulated on the first postoperative day and were allowed oral liquids by the 7th postoperative day. Compared with patients who underwent an open colonic bypass, there was significantly less need for analgesics. At a median follow-up of 5 (range 3-6) months, all patients are euphagic to solid diet and have excellent cosmetic results. CONCLUSION Laparoscopic colonic bypass is an achievable, safe, and effective procedure for the management of corrosive strictures of the esophagus.
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Affiliation(s)
- Amit Javed
- Department of GI Surgery, GB Pant Hospital and MAM College, Delhi University, New Delhi, 110002, India
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Ozkan Gurdal S, Yucel T, Oran M, Remzi Soybir G, Nihat Koksoy F, Mete R. Our Experiences on Injuries due to Corrosive Intake. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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