Ramesh Lingala1, Ramesh Kota2
BACKGROUND
Corrosive injury to the upper gastrointestinal tract is an agonising experience for both the patient and surgeon. Caustic ingestion may cause wide spread injury to the lips, oral cavity, pharynx and the upper airway. The effect that these agents have on the oesophagus accounts for most of the serious injuries and on stomach, which may result in perforation and death in the acute phase.1,2 If the patient survives the acute effects of caustic ingestion, the reparative response leads to the development of oesophageal and gastric strictures. There is also an increased incidence of oesophageal and gastric cancer in the longterm.3,4,5 These patients present with the most distressing symptoms of dysphagia and are not able to swallow even liquids sometimes. For a surgeon, it is necessary to restore the GI continuity, so that the patients may be relieved of symptoms and can take food naturally for the rest of their lives. An insight is made into the various modalities of treatments available for corrosive effects of oesophagus and stomach.6,7 Even though majority of oesophageal strictures can be managed by modern endoscopic interventional methods, surgery is mandatory in few cases. Surgery is the only modality of treatment for gastric complications. Corrosive injuries continue to result in high morbidity and mortality until more conclusive diagnostic and treatment recommendations can be made.
Present study was done to know the effects of corrosive poisoning on upper gastrointestinal tract to evaluate the common surgical procedures in the management of corrosive poisoning and to know the mortality and morbidity after corrosive poisoning.
MATERIALS AND METHODS
It is a prospective observational study conducted at a tertiary care hospital in between December 2014 to December 2016. All the patients were evaluated by history, clinical examination and radiological examination. Treatment was given according to the severity of the injury. The modes of presentation, injury to the upper GI tract, surgical methods of treatment, morbidity and mortality were observed.
RESULTS
There were 50 corrosive ingestions, 43 patients with acid injury, 7 patients with alkali injury. Of 50 cases, 32 patients underwent FJ of which 4 patients were lost to follow up. Of 43 cases of acid injury- 8 were oesophageal strictures, 3 cases had (37.5%) gastric transposition and 5 cases (62.5%) had colonic interposition. Of 7 cases of alkali injury- 1 case (14.28%) had gastric transposition and 1 case (14.28%) had colonic interposition. All of them were done through substernal route. Of 43 patients of acid injury- 19 were gastric strictures, 7 cases (36.84%) managed by gastrojejunostomy and 5 cases by Billroth-I gastrectomy (26.31%) and 7 cases (36.84%) by Billroth-II gastrectomy. Of 7 cases of alkali injury, 1 case (14.28%) was managed by gastrojejunostomy. Of 8 cases of oesophageal stricture of acid injury, 3 cases (37.5%) postoperative period was uneventful, 2 cases (25%) developed wound infection, 2 cases (25%) developed hoarseness of voice and anastomotic leak and 1 case (12.5%) developed chest pain. Of all 2 cases of oesophageal stricture of alkali injury had normal outcome. Of 19 cases of gastric strictures, 17 cases (89.47%) had normal outcome, 1 case (5.26%) developed dumping syndrome, 1 case (5.26%) developed wound infection. Of 1 case of gastric stricture of alkali injury had normal outcome. Of 50 cases studied, 46 (92%) cases were survived, 4 cases (8%) were expired due to extensive injury of oesophagus and stomach, thus success rate of 92% and mortality of 8%.
CONCLUSION
1). Acid corrosive injury is more common in India unlike in the west. 2). Acid affects both oesophagus and stomach, thus oesophagus is not immune from injury due to acid ingestion. 3). Long segment of oesophagus is most commonly involved in corrosive injury, and in stomach, antrum is most commonly involved. 4). All the aforementioned procedures for oesophageal and gastric strictures were fruitful. 5). Health education regarding the effects of corrosive ingestion should be carried out in a large scale. 6). A long-term surveillance of the patients is required to detect early malignancy changes.
