Corrosive burns of the esophagus and stomach: A recommendation for an aggressive surgical approach

A. Estrera, W. Taylor, L. J. Mills, M. R. Platt

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

During a six-year period ending in December, 1980, 62 patients with a history or clinical evidence of corrosive ingestion were admitted into our institutions. The majority were adults who had attempted suicide. Strong alkali (lye), the most common corrosive agent involved, was ingested by more than half of the patients (39). The remaining 23 patients had ingested weak alkali or nonalkali corrosive agents. Of the 27 patients with severe esophagogastric burns (second- and third-degree), a 43.5% incidence overall, liquid lye was responsible in 21, including 7 of 8 patients with extensive full-thickness esophagogastric necrosis. In sharp contrast, only 1 of the 23 patients who had ingested weak alkali or nonalkali corrosive agents had serious esophagogastric injury. In the first two years of this review, the management approach was the so-called standard one (esophagoscopy, steroids, antibiotic, and dilation) (Group 1). The results were disappointing. In 5 of 9 patients with endoscopic findings of second-degree burns, stricture requiring dilation developed, and all 4 with extensive full-thickness esophagogastric necrosis died. In contrast, during the last four years, with the adoption of a more aggressive surgical approach, that is, early surgical intervention including the use of an intraluminal esophageal stent and radical resection as indicated, missed or delayed diagnosis of full-thickness esophagogastric necrosis with its prohibitive mortality was avoided and the complication of severe esophageal stricture was virtually eliminated (Group 2). All 5 patients in this series who died (8% mortality) had extensive esophagogastric necrosis; 4 deaths resulted from injury caused by liquid lye ingestion. Delay in making the diagnosis, and thus delay in the management of transmural esophagogastric necrosis, is the single most important contributing factor to this significant mortality.

Original languageEnglish (US)
Pages (from-to)276-283
Number of pages8
JournalAnnals of Thoracic Surgery
Volume41
Issue number3
StatePublished - 1986

Fingerprint

Caustics
Burns
Esophagus
Stomach
Lye
Necrosis
Alkalies
Mortality
Dilatation
Eating
Esophagoscopy
Esophageal Stenosis
Attempted Suicide
Delayed Diagnosis
Wounds and Injuries
Stents
Pathologic Constriction
History
Steroids
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Corrosive burns of the esophagus and stomach : A recommendation for an aggressive surgical approach. / Estrera, A.; Taylor, W.; Mills, L. J.; Platt, M. R.

In: Annals of Thoracic Surgery, Vol. 41, No. 3, 1986, p. 276-283.

Research output: Contribution to journalArticle

Estrera, A, Taylor, W, Mills, LJ & Platt, MR 1986, 'Corrosive burns of the esophagus and stomach: A recommendation for an aggressive surgical approach', Annals of Thoracic Surgery, vol. 41, no. 3, pp. 276-283.
Estrera, A. ; Taylor, W. ; Mills, L. J. ; Platt, M. R. / Corrosive burns of the esophagus and stomach : A recommendation for an aggressive surgical approach. In: Annals of Thoracic Surgery. 1986 ; Vol. 41, No. 3. pp. 276-283.
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