RETROSPECTIVE AND PROSPECTIVE STUDY OF CORROSIVE POISONING AND ITS EFFECT ON UPPER GASTRO INTESTINAL TRACT AND SURGICAL MANAGEMENT IN TERTIARY CARE CENTRE

Background: Corrosive injury to the upper gastrointestinal tract is an insufferable experience for both the patient and surgeon. Corrosive ingestion may usually responsible for wide spread injury to the lips, oral cavity, oropharynx and the upper air way, upper gastrointestinal tract. Results: in our study more common patients were in the age group 21-30 years. Majority of the patients had consumed toilet cleaner. Majority of the patients had consumed substance of <=30 ml. Majority of the patients had consumed HCL. Majority of the patients had consumed the substance with a suicidal Intention, [ 42.9%] consumed corrosive under influence of alcohol, In 5 (14.3%) patients had oropharynx involvement, in 8 (22.9%) patients had lower esophagus involvement, in 8 (22.9%) patients had middle esophagus involvement and 17 (48.6%) patients had upper esophagus involvement. In 18 (51.4%) patients had pylorus (stomach) involvement and in 5 (14.3%) patients duodenum (first part) involvement. In 11 (31.4%) patients esophagus was involved at 2A level, in 17 (48.6%) patients esophagus was involved at 2B level and in 2 (5.7%) patients esophagus was involved at 3A level. In 9 (26.5%) patients dilatation was not possible, in 2 (5.9%) patients it was not done. In 9 (26.5%) dilatation was done 2 times and in 14 (41.1%) patients dilatation was done 3 times .In 34 (97.1%) patients feeding jejunostomy insertion was done in 1 (2.9%),most common sequels esophageal stricture [65.7%] and GOO[40%], patient laparotomy Bilroth II gastrectomy was done as a primary intervention. Majority of the patients complained of dysphagia and chest pain and cough at first visit. In 11 (32.4%) patients gastrojejunostomy was done, in 7 (20.6%) patients esophagectomy with gastric pull-up was done, in 4 (11.8%) patient’s thoracoscopic esophagectomy with colonic interposition was done. There were 3 (8.6%) deaths and 32 (91.4%) patients were discharged successfully in our study there was a significant improvement seen in the weight from follow-up at 2 months till the end of follow-up at 12 months (p<0.05). Conclusion: In our study corrosive ingestion common in young age decrees, with increase age, (HCL) toilet cleaner found to be the commonest corrosive chemical used esophags most common than pylorus affected by the ingestion, oropharynx and duodenum less likely,2Bgrade of injury was affected the most in esophagus, stomach or duodenum, with a very high incidence of stricture formation. Dysphagia, throatpain, excessive salivation and hoarseness of voice were the commonest presenting symptoms. The first line of performed surgery at presentation was insertion of feeding jejunostomy and improvement in diet intake and strength of feeding jejunotomy patients underwent gastrojejunostomy, esophagectomy with gastric pull-up or thoracoscopic esophagectomy with colonic interposition. Dilatation was required in majority of the patients. There was a significant improvement in the weight of these patients over various follow-up periods. The overall success rate of management of these patients was found to be very high with only a very few deaths recorded in our study. Keywords: Corrosive injury, Esophagealstricture, Gastric outlet obstruction, Upper GI endoscopy.

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Corrosive injury of upper gastrointestinal tract and it outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20171603 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1594 ◽

Cited By ~ 1

Author(s):

Uday Shankar Baluni ◽

Tejas Mistry ◽

Ankur Kothari ◽

Tejas Patel

Keyword(s):

Gastrointestinal Tract ◽

Clinical Symptoms ◽

Feeding Jejunostomy ◽

Corrosive Injury ◽

History Of ◽

Grade 3 ◽

Considerable Morbidity ◽

Upper Gastrointestinal ◽

Corrosive Ingestion

Background: Corrosive gastrointestinal tract injuries are a source of considerable morbidity all over the world and differ in their presentations.Methods: In the present work, study was done on 41 patients with history of acute corrosive injury with a period of 24 hours of ingestion and analysis on the parameters of age, sex, mode of ingestion, nature of corrosive, clinical symptoms. Further UGI scopy was also done within 24 to 48 hours of admissions.Results: With the study it was found that, the incidence of corrosive ingestion was reducing as the age was increasing and among all patients 27 were females and only 14 were males. The most common cause of corrosive ingestion was suicidal found in 30 cases and only 11 were accidental and most common nature of corrosive used was acid. 2 patients get expired during the initial resuscitation. On GI scopy, 18 have grade 1, 12 have grade 0, 4 have grade 2 and 7 have grade 3 according to Zargar classification. Initially 35 patients were given conservative treatment and 4 cases were treated surgically by feeding jejunostomy. On follow up 31 were advised for conservative management and 7 required surgical management, out of which esophageal dilatation was done in 2 cases, esophageactomy in 2 cases and gastrojejunostomy was done in cases and one case get expired.Conclusions: Corrosive ingestion patient are managed on the basis of UGI scopic grading.

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Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist

British Journal of Radiology ◽

10.1259/bjr.20200528 ◽

2020 ◽

Vol 93 (1114) ◽

pp. 20200528

Author(s):

Ayushi Agarwal ◽

Deep Narayan Srivastava ◽

Kumble Seetharama Madhusudhan

Keyword(s):

Gastrointestinal Tract ◽

Ct Scan ◽

Upper Gastrointestinal Tract ◽

Stricture Formation ◽

Emergency Setting ◽

Oral Contrast ◽

Long Term Outcome ◽

Corrosive Injury ◽

Upper Gastrointestinal

Corrosive injury is a devastating injury which carries significant morbidity. The upper gastrointestinal tract is predominantly affected with severity ranging from mild inflammation to full thickness necrosis which may result in perforation and death. Among the complications, stricture formation is most common, causing dysphagia and malnutrition. Endoscopy has a pivotal role in the diagnosis and management, with a few shortcomings. Imaging has an important role to play. Besides radiography, there is an increasing role of CT scan in the emergency setting with good accuracy in identifying patients who are likely to benefit from surgery. Further, CT scan has a role in the diagnosis of complications. Oral contrast studies help in assessing the severity and extent of stricture formation and associated fistulous complications in the subacute and chronic phase. The scope of intervention radiology for this condition is increasing. Fluoroscopy-guided balloon dilatation, drainage of collections or mucoceles, endovascular embolization of point bleeders, placement of feeding jejunostomy and image-guided biopsy are among the procedures that are being performed. Through this review we aim to stress the role the radiologist plays in the diagnosis and follow-up of these patients and in performing radiological interventions. Besides this, we have also highlighted few salient points to help understand the pathophysiology and management of such injuries which is paramount to ensure a good long-term outcome.

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Upper Gastrointestinal Tract Crohn's Disease

Canadian Journal of Gastroenterology ◽

10.1155/1990/758048 ◽

1990 ◽

Vol 4 (1) ◽

pp. 26-32 ◽

Cited By ~ 3

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Treatment Options ◽

Upper Gastrointestinal Tract ◽

Distal Intestine ◽

The Subject ◽

Atypical Presentations ◽

Upper Gastrointestinal

Crohn's disease may involve any site within the gastrointestinal tract. Usually pathology is present in the ileum and/or colon, but atypical presentations may occur with apparently 'isolated' involvement of the oropharynx, esophagus or gastroduodenum. If changes typical of Crohn's disease are detected in the upper gastrointestinal tract, then a careful assessment is required involving radiographic, endoscopic and histologic studies to determine if pathology is present in more distal intestine. In addition , microbiologic studies may be important to exclude infectious causes, especially of granulomas. If these studies are negative, prolonged follow-up may be required to establish a diagnosis of Crohn's disease. Although upper gastrointestinal involvement is increasingly recognized as a significant cause of morbidity in Crohn's disease, the treatment options are limited , largely anecdotal and need to be the subject of detailed epidemiologic investigation and clinical trials.

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Corrosive injury of upper gastrointestinal tract by calcium oxide

Indian Journal of Gastroenterology ◽

10.1007/s12664-019-00992-1 ◽

2019 ◽

Vol 38 (5) ◽

pp. 460-461

Author(s):

Mihoko Yoshida ◽

Yosuke Matsumoto ◽

Takanobu Suzuki ◽

Satoshi Nishimura ◽

Takahiro Kato ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Calcium Oxide ◽

Upper Gastrointestinal Tract ◽

Corrosive Injury ◽

Upper Gastrointestinal

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Secretion of colonic isozyme of lysozyme in association with cecotrophy of rabbits

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1984.247.1.g19 ◽

1984 ◽

Vol 247 (1) ◽

pp. G19-G23 ◽

Cited By ~ 3

Author(s):

V. M. Camara ◽

D. J. Prieur

Keyword(s):

Gastrointestinal Tract ◽

Lysozyme Activity ◽

Upper Gastrointestinal Tract ◽

Colonic Lumen ◽

Upper Gastrointestinal ◽

Very High

The relation between the rabbit gastrointestinal (colonic) isozyme of lysozyme and the unique circadial coprophagic behavior of rabbits, termed "cecotrophy," was investigated. We found that lysozyme activity was very low in all segments of the rabbit gastrointestinal tract proximal to the fusus coli. However, the distal or nonsacculated colon, located distal to the fusus coli, had very high lysozyme activity throughout. It was determined, furthermore, that the lysozyme in the wall of the nonsacculated colon was secreted circadially into the colonic lumen in association with the circadial production of soft feces that were destined for reingestion by cecotrophy. The colonic lysozyme, therefore, was transferred to the stomach. These observations suggest that rabbit colonic lysozyme may have a possible function in the upper gastrointestinal tract and be analogous to ruminant abomasal-duodenal lysozyme.

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Corrosive Injuries of the Upper Gastrointestinal Tract

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_24_16 ◽

2017 ◽

Vol 08 (04) ◽

pp. 165-169

Author(s):

Babu Lal Meena ◽

Kumar Shwetanshu Narayan ◽

Gopal Goyal ◽

Surendar Sultania ◽

Sandeep Nijhawan

Keyword(s):

Gastrointestinal Tract ◽

Outlet Obstruction ◽

Clinical Problem ◽

Upper Gastrointestinal Tract ◽

Esophageal Injury ◽

Caustic Ingestion ◽

X Rays ◽

Corrosive Injury ◽

Airway Injury ◽

Upper Gastrointestinal

ABSTRACTCorrosive injury of the upper gastrointestinal tract is a worldwide clinical problem, mostly occurring in children. Alkaline agents produce deeper injuries whereas acidic agents produce superficial injuries usually. Hoarseness, stridor, and respiratory distress indicate airway injury. Dysphagia, odynophagia, and drooling of saliva suggest esophageal injury whereas abdominal pain, nausea, and vomiting are indicative of stomach injury. X-rays should be done to rule out perforation. Endoscopy is usually recommended in the first 12–48 h although it is safe up to 96 h after caustic ingestion. Endoscopy should be performed with caution and gentle insufflation. Initial management includes getting intravenous access and replacement of fluids. Hyperemia and superficial ulcerations have excellent recovery while deeper injuries require total parenteral nutrition or feeding jejunostomy. Patients suspected of perforation should be subjected to laparotomy. Common complications after corrosive injury are esophageal stricture, gastric outlet obstruction, and development of esophageal and gastric carcinoma.

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Usage characteristics and adverse event rates of the direct puncture and pull techniques for percutaneous endoscopic gastrostomy in patients with malignant tumors of the upper aerodigestive tract

Endoscopy International Open ◽

10.1055/s-0043-121879 ◽

2018 ◽

Vol 06 (01) ◽

pp. E29-E35 ◽

Cited By ~ 1

Author(s):

Niels Teich ◽

Lars Selig ◽

Susanne Liese ◽

Franziska Schiefke ◽

Alexander Hemprich ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Adverse Events ◽

Percutaneous Endoscopic Gastrostomy ◽

Malignant Tumors ◽

Short Term ◽

Direct Puncture ◽

Endoscopic Gastrostomy ◽

Upper Gastrointestinal

Abstract Background and study aims Patients with malignant tumors of the upper gastrointestinal tract are at risk of weight loss. Early supportive nutrition therapy is therefore recommended and usually requires placement of a percutaneous endoscopic gastrostomy (PEG). The aim of this study was to compare adverse events and usage characteristics of the direct puncture technique with those of the traditional pull technique when used in patients with endoscopically passable tumors. The primary endpoint was the rate of inflammatory adverse events (AEs) at the gastrostomy fistula. The secondary endpoint was the long-term rate of puncture-site metastases. Patients and methods One hundred twenty patients (median age 56; IQR 36, 86 years) were randomized and treated per protocol in this prospective open randomized single-center study. Follow-ups were conducted on the third and seventh post-interventional days, after 1, 3 and 6 months and the last follow-up 5 years after intervention. Results Within the short-term follow-up period of 6 months after PEG placement, AEs were noted in 47 patients (39.2 %). These included 22 inflammations and 16 device dislocations and were mainly found in the puncture group (33 vs. 14 in the pull group) with a significantly increased incidence in the first month after PEG insertion (P = 0.001). Evaluation of the 5-year data did not reveal any significant differences. The gastrostomy tube was used in 101 patients (84.2 %) (range 18 days to 5 years). Conclusions Our results favor the pull technique for patients with endoscopically passable tumors of the upper gastrointestinal tract due to less short-term adverse events. Both systems contributed equally to secure long-term use.

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