title: Tracheobronchial Necrosis After Caustic Ingestion.
abstract: OBJECTIVE
  The aim of this study was to describe the management and outcome of tracheobronchial necrosis (TBN) after caustic ingestion.
  
  
  BACKGROUND
  Emergency pulmonary patch repair has been reported to be lifesaving in patients with caustic TBN.
  
  
  METHODS
  Patients who underwent management of caustic TBN between 1989 and 2013, were included. TBN was defined as early if present on admission and late if occurring thereafter. Operative outcomes, long-term survival, and functional outcomes were compared with those of 269 patients without TBN who underwent esophagectomy for caustic injuries.
  
  
  RESULTS
  Twenty patients were included (10 men; median age = 39 years). Early TBN was detected in 14 patients, and late TBN occurred in 7 patients, 8 days (range:: 6-10 days) after admission. TBN involved the left bronchus (n = 17; 85%), the carina (n = 10; 50%), the supracarinal trachea (n = 9; 45%), the right bronchus (n = 4; 20%), and the cervical trachea (n = 3; 15%). Seventeen patients underwent esophagogastrectomy, 2 underwent esophagectomy, and in 1 patient, resection was eventually abandoned. Pulmonary patch repair was performed in 16 patients (80%). Nine patients (45%) died and morbidity was 100%. In univariate analysis, late TBN (P = 0.017) and acid ingestion (P = 0.002) were predictors of mortality. All survivors underwent restoring colopharyngoplasty. Five-year survival (28%) and functional success (25%) rates were significantly impaired when compared with esophagectomy patients without TBN.
  
  
  CONCLUSIONS
  TBN is one of the most devastating complications of caustic ingestion. Pulmonary patch repair is technically simple and can be lifesaving in this difficult situation.
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Université Paris 7 Diderot, Paris, France.
authors.forename: Barak
authors.initials: B
authors.lastname: Benjamin
authors.forename: Rafika
authors.initials: R
authors.lastname: Agueb
authors.forename: Helene
authors.initials: H
authors.lastname: Vuarnesson
authors.forename: Hadrien
authors.initials: H
authors.lastname: Tranchart
authors.forename: Nicolas Munoz
authors.initials: NM
authors.lastname: Bongrand
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
mesh_terms: D000328:Adult; D001980:Bronchi / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D002057:Burns, Chemical / Q000473:pathology* / Q000601:surgery; D002424:Caustics / Q000633:toxicity*; D016629:Esophagectomy; D004947:Esophagus / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D012189:Retrospective Studies; D014132:Trachea / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D002424:Caustics