Clinical features of corrosive ingestion.

OBJECTIVE: To study the clinical presentation after corrosive ingestion. SETTING: A University Hospital. DESIGN: Prospective descriptive study. PATIENTS AND METHOD: Corrosive ingestion patients were studied, from July 2000 to December 2002. Reasons for ingestion, symptoms, physical findings and routine investigations were recorded in a standard form. Data analysed using the descriptive statistical method. RESULTS: There were 73 patients, 55 women and 18 men, median age 22 years, 48 (65.8%) of whom had ingested strong acid, 3 (4.1%) ingested strong alkali. Suicidal gesture was the most common reason for ingestion (89.2%). The amount of ingestion was less in accidental cases. Symptoms of nausea/vomiting, drooling and abdominal tenderness were associated with the amount of ingestion, while severity of lips, buccal mucosa and palate injuries was significantly related with strong corrosive agents (p < 0.05). Leucocytosis was found in patients who had symptoms of drooling, hoarseness, stridor and signs of mucosal slough or superficial ulcers (p < 0.05). Four required surgery. Two of them had esophago-gastrectomy. Twenty-one patients were followed-up, with the median follow-up time of 11 (1-28) months. One patient died from HIV infection. The rest were normal. CONCLUSION: Drooling and oral mucosal slough or ulcers were significant findings and were related to the amount and strength of the corrosive substance ingested, respectively. To meet the goal of a holistic approach, attention must also be given to psychiatric management, and surgeons should provide a supportive role.

Is there a difference between the management of grade 2b and 3 corrosive gastric injuries?

OBJECTIVE: To evaluate the differences between treatment of patients with grade 2b or grade 3 gastric injuries. SETTING: A University Hospital. DESIGN: Retrospective review. PATIENTS: Thirty patients who ingested caustic agents over a 5 year period were examined by endoscope within 48 hours of injury. RESULT: Twenty one patients ingested strong acid or alkali. Among these patients, five had grade 2b, and two had grade 3 injuries. In both cases of grade 3 injuries, extensive surgical approach was initially performed, then delayed jejunal and colonic interpositions were done. On the other hand, one 2b patient had exploratory laparotomy, while others were treated conservatively. All 2b patients had satisfactory conditions during the initial follow-ups. Three patients were healthy during the 11, 16, and 44 months follow-up, one developed chronic gastritis at 5 months and one patient failed to follow-up. CONCLUSION: Early and aggressive extensive removal of necrotic tissue is necessary and can certainly increase the survival. There is on going controversy in the management of injuries less than grade 3. Grade 2b gastric injury patients can be managed conservatively.