title: Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes.
abstract: BACKGROUND
  Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae.
  
  
  METHODS
  The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies.
  
  
  CONCLUSIONS
  Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Antonios I
authors.initials: AI
authors.lastname: Vezakis
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eirini V
authors.initials: EV
authors.lastname: Pantiora
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Elissaios A
authors.initials: EA
authors.lastname: Kontis
authors.affiliation: Department of Surgery, St Luke's Hospital, Panorama, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Sakellariou
authors.affiliation: Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, "Hippokration" General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Theodorou
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gkiokas
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Polydorou
authors.affiliation: 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Fragulidis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000150:complications*; D002424:Caustics / Q000633:toxicity*; D004636:Emergency Service, Hospital; D004940:Esophageal Stenosis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013270:Stomach / Q000293:injuries*
chemical_list: D002424:Caustics