title: [Extensive digestive caustic burns: what are the limits for resection? A series of 12 patients].
abstract: OBJECTIVE
  To report the results of oesogastric resections extended to surrounding organs following caustic ingestion, and to precise indications for resection and results of reconstruction.
  
  
  METHODS
  From 1988 to 2001, 12 patients underwent oesophago-gastrectomy, extended to duodenum and pancreatic head (n = 6), jejunum (n = 4), colon (n = 2), spleen (n = 2) or pancreatic body (n = 1). Early morbidity and mortality, specificities of reconstruction, and quality of oral feeding were assessed retrospectively.
  
  
  RESULTS
  Mean intensive care unit stay was 50 days (range: 16-152 days). All patients developed complications. Six patients were reoperated for secondary extension of caustic burns, mainly to colon (n = 4), small bowel (n = 2) and pancreas (n = 2). Three patients died on postoperative days 17, 20, and 130. Secondarily, eight patients (75%) underwent a substernal right ileocoloplasty. Six patients (50%) survived initial resection, and esophageal reconstruction. After a mean follow-up of 35 months (range: 7-87 months), four patients (33%) eat normally.
  
  
  CONCLUSIONS
  After caustic burn, oesogastric resections extended to surrounding organs are associated with high morbidity and mortality. However, return of normal oral feeding can be expected in 33% of cases. Secondary extension of caustic burns to adjacent organs is a common eventuality, and may lead to prompt reintervention. Massive injury to small bowel or colon may compromise digestive function or secondary esophageal reconstruction, and thus may be the reasonable limit for resection.
authors.affiliation: Service de chirurgie digestive et endocrinienne, hôpital Saint-Louis, AP-HP, Université Paris VII, France.
authors.forename: N
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: P
authors.initials: P
authors.lastname: Cattan
authors.forename: C
authors.initials: C
authors.lastname: de Chaisemartin
authors.forename: H
authors.initials: H
authors.lastname: Bothereau
authors.forename: I
authors.initials: I
authors.lastname: Honigman
authors.forename: E
authors.initials: E
authors.lastname: Sarfati
mesh_terms: D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002424:Caustics