Corrosive injury of the upper gastrointestinal tract: review of surgical management and outcome in 14 adult cases.
BACKGROUND
Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion.


METHODS
Between Nov1993 to march 2011, 14 adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals). Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery.


RESULTS
14 patients (10men and 4 women) with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in 2 survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient.


CONCLUSIONS
Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.
Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital , School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran .
Mohammad Taghi
MT
Rajabi
Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital , School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran .
Ghodratollah
G
Maddah
Cardio- Thoracic Surgery & Transplant Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Reza
R
Bagheri
Surgical Oncology Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mostafa
M
Mehrabi
Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital , School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran .
Hossein
H
Shabahang
Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital , School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran .
Farjad
F
Lorestani
Caustic ingestion; Esophageal replacement; Esophageal stricture.