[Emergency surgical management of lesions from ingestion of caustics. Role of primary endoscopic classification]. / Indicazioni alla chirurgia d'urgenza nelle lesioni da ingestione di caustici. Ruolo di una classificazione endoscopica originale.

Management of caustic ingestion in adults improved in the last decade due to the new diagnostic developments, the better predictability of injuries from signs and symptoms, the intensive care improvements and the more aggressive surgical approach for the most severe lesions. In fact, the early surgical treatment of severe lesions for ingestion of caustic and corrosive substances may reduce mortality, morbidity and hospitalization. The role of early endoscopic examination is today worldwide accepted: is herein proposed a new endoscopic classification of caustic lesions adjusted after a retrospective analysis of a twenty years experience in this field, and applied in twelve patients affected by severe esophageal and gastric injuries then submitted to emergency surgical treatment and survived. It showed a great usefulness in selection of patients to submit immediately to surgery and may play a fundamental role in indications and timing of surgical management of severe injuries by caustic ingestion.

[Artificial nutrition in the management of lesions caused by caustic ingestion]. / La nutrizione artificiale nelle lesioni da ingestione di caustici.

Ingestion of a large amount of corrosive agent results in a life-threatening condition which requires a much more aggressive diagnostic and therapeutic approach than was formerly recommended. Based on experience with a wide spectrum of upper g-i injuries in 56 patients treated through a 5-year-period, the Authors suggest an early staging of the lesions by immediate endoscopy, followed by adequate resective surgery for high-degree esophago-gastric lesions. Indications, techniques of artificial nutrition and the nutritional requirements of this condition are presented and fully discussed. The prompt institution of total parenteral nutrition is an essential part of the emergency management of these lesions. Fourteen patients underwent surgical treatment for the lesions; in all cases a Witzel's feeding jejunostomy was performed and postoperative enteral nutrition was started. Eight patients underwent a reconstructive operation of colon interposition and received home-based total enteral nutrition for a period of 8-25 weeks. No major complications relate to nutritional support occurred and nutritional indexes were normal at the end of the treatment.