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

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.

Acid corrosive injury of stomach: management and long-term outcome

Background: Acid corrosive injury to stomach is not uncommon in India due to easy availability. Corrosive ingestion results in significant morbidity. We present our experience in surgical management of such cases. The aims and objectives of this study to review the experience of surgical management of gastric corrosive injury and to assess long term outcome and functional results.Methods: This study was retrospective analysis of prospectively collected data of 23 cases of acid corrosive injury managed in a single surgical unit.Results: Median age was 31 years, male to female ratio was 12:11. Surgical procedures were tailored according to extent and degree of stricture. Posterior gastrojejunostomy was done in 8 (38.0%) cases, near total gastrectomy in 3 (14.3%) cases, total gastrectomy and Billroth I in 2 (9.5%) cases each. 4 cases were lost to follow up after preliminary feeding jejunostomy. 2 cases had mortality after feeding jejunostomy. 2 cases were managed successfully without active surgical intervention. All patients undergoing definitive procedure had good results in terms of nutritional status and symptoms of gastric outlet obstruction.Conclusions: The outcome of gastric stricture secondary to acid ingestion can be significantly improved by adequate preoperative preparation and planned approach depending upon type of injury.

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.

Severe ARDS Complicating an Acute Intentional Cresol Poisoning

Cresol is a phenol derivative used as a disinfectant that may cause gastrointestinal corrosive injury, central nervous system, cardiovascular disturbances, renal, and hepatic injury following intoxication. We present a case of a female patient who was admitted to the emergency department after ingesting an unknown amount of cresol; she was admitted with tachypnea, shortness of breath with low oxygen level in the blood. She did not develop hepatic or renal dysfunction. The gastrointestinal endoscopy was performed and showed esophagus and gastric erosins only. The patient was sedated and ventilated for 7 days. After receiving supportive intensive care, the patient recovered and was sent for psychiatric evaluation. Cresol intoxication can be fatal, and cause a respiratory failure with an acute respiratory distress syndrome (ARDS), hepatic, and renal injury. This shows the importance of intensive care in the management of cresol poisoning.