title: Different possible surgical managements of caustic ingestion: diagnostic laparoscopy for Zargar's grade 3a lesions and a new technique of "Duodenal Damage Control" with "4-tubes ostomy" and duodenal wash-out as an option for extensive 3b lesions in unstable patients.
abstract: In the present study, we have described two possible approaches in the management of caustic injuries. Diagnostic emergency laparoscopy can be used for exploration in case of stable patients with Zargar's 3a gastric lesions and equivocal peritoneal signs. On the other hand, in case of patients with Zargar's 3b gastric lesions with perforation, diffuse peritonitis and hemodynamic instability, a new possible technique is described as an option to be used in such extensive caustic injuries: duodenal damage control with "4-tubes ostomy" for duodenal and jejunal wash-out of the caustic agent. The aim of this simple technique is to wash-out the caustic agent from the duodenum when the duodenum and Treitz are not yet gangrenous/perforated, as well as to avoid duodenal primary closure and jejuno-jejunal anastomosis over damaged tissues.
authors.affiliation: Trauma Surgery Unit, Maggiore Hospital Trauma Center, Maggiore Hospital CA Pizzardi, L.go Nigrisoli 2, Bologna Local Health District, Bologna, Italy, salo75@inwind.it.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.forename: Andrea
authors.initials: A
authors.lastname: Biscardi
authors.forename: Alice
authors.initials: A
authors.lastname: Piccinini
authors.forename: Matteo
authors.initials: M
authors.lastname: Mandrioli
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
mesh_terms: D000368:Aged; D002057:Burns, Chemical / Q000175:diagnosis / Q000601:surgery*; D004385:Duodenostomy / Q000295:instrumentation*; D004386:Duodenum / Q000293:injuries / Q000601:surgery*; D016145:Endoscopy, Digestive System; D004947:Esophagus / Q000293:injuries / Q000601:surgery; D005260:Female; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal; D007583:Jejunum / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D013270:Stomach / Q000293:injuries / Q000473:pathology / Q000601:surgery; D007507:Therapeutic Irrigation / Q000295:instrumentation*