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.


METHODS
A University Hospital.


METHODS
Retrospective review.


METHODS
Thirty patients who ingested caustic agents over a 5 year period were examined by endoscope within 48 hours of injury.


RESULTS
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.


CONCLUSIONS
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.
Department of Surgery, Faculty of Medicine, Thammasart University, Bangkok, Thailand.
Chittinad
C
Havanond
D000293:Adolescent; D000328:Adult; D002057:Burns, Chemical / Q000628:therapy*; D002424:Caustics / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005753:Gastric Mucosa / Q000293:injuries / Q000473:pathology; D006801:Humans; D006851:Hydrochloric Acid / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries*
D002424:Caustics; D006851:Hydrochloric Acid