title: [Tailored surgical treatment for post-caustics stenosis of the upper digestive tract with complicated lesions. Clinical experience at our department in the last ten years].
abstract: The ingestion of caustic substances generates severe lesions of superior digestive tract, leading to stenosis in 50% of patients, of which almost 50% will require surgical treatment. A number of 29 patients with caustic lesions were treated in the IIIrd Surgical Unit from 1993 to 2004. The most frequent corrosive agent was a strong alkaline solution. The location of the post caustics strictures was esophageal in 18 cases, esophagogastric in 7 cases and laryngo-pharyngo-esophageal in 4 cases. Surgical procedures consisted of 8 esophagoplasties with ascending colon and ileum, 12 with left colon, 3 with transverse colon and splenic flexure, and in 5 cases transhiatal resection with cervical esophago-gastric anastomosis. 5 patients required gastric resections of variable extent, in addition to the esophageal reconstruction: antrectomy with trunk vagotomy--1 case, subtotal gastrectomy--3 cases and total gastrectomy--1 case. In the group with pharyngeal lesions, esophageal reconstruction followed pharyngoplasty with cutaneous tube performed in the ENT department. Hospital mortality rate was 3,4 % (1 case). Postoperative morbidity of 20,6 % consisted of cervical anastomosis leakages in 2 cases and pleural effusions in 4 cases. Surgical treatment of the post caustics strictures of the upper digestive tract must be adapted to the location and severity of the lesions, requiring adequate operative experience and special pre- and postoperative care.
authors.affiliation: Universitatea de Medicină şi Farmacie Gr T Popa Iaşi, Facultatea de Medicină, Clinica a III-a Chirurgie.
authors.forename: Cristina
authors.initials: C
authors.lastname: Dăscălescu
authors.forename: Cr
authors.initials: C
authors.lastname: Bulat
authors.forename: R
authors.initials: R
authors.lastname: Dănilă
authors.forename: Cr
authors.initials: C
authors.lastname: Dragomir
authors.forename: M
authors.initials: M
authors.lastname: Stoian
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002057:Burns, Chemical / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D002424:Caustics / Q000009:adverse effects*; D003106:Colon / Q000637:transplantation; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000401:mortality / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005756:Gastritis / Q000139:chemically induced / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000637:transplantation; D007818:Laryngeal Diseases / Q000139:chemically induced / Q000601:surgery; D008297:Male; D010608:Pharyngeal Diseases / Q000139:chemically induced / Q000601:surgery; D012189:Retrospective Studies; D012383:Romania / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D002424:Caustics