Acid burns of upper gastrointestinal tract produce a complex combination of lesions which can be grouped into five types, and existing surgical techniques have proved inadequate in treating some of these lesions. Over the past 25 years 72 patients have needed operative treatment since they could not be managed by more conservative measures; the anatomical lesions in the five types and their surgical management are described.
Different surgical management is needed in each patient, such as pure gastric burn with contracted stomach, stricture of esophagus sparing the pharingo-laryngeal area, combined with or without destroyed stomach, extensive burns from pharynx to esophagus and stomach, vitamin B12 deficiency following extensive repair.
Dear Saibal Gupta,
Corrosive ingestion can cause different injuries ranging from mucosal erythema to transmural necrosis of the esophagus and/or stomach. Endoscopy should be performed within 48 hours of the ingestion in order to estimate the degree of damages. The treatment could be conservative or surgical. Emergency surgery is indicated for free perforation, progressive mediastinitis, hemorrhage or peritonitis. While in patients with I or II degree burns surgery is not necessary, a indicated surgical approach is needed for high-degree burns depending on the complications established.
According my longtime experience with over 400 injured children I recommend aggressive surgical approach - emergency surgical exploration in patients with grade 3b – 4 injuries of the upper gastrointestinal tract. Esophagectomy is performed in all patients with full-thickness esophageal necrosis, while partial resection or even gastrectomy is indicated in cases of localized or diffuse necrosis of the gastric wall. The endoscopic follow up can give reason to perform delayed surgery, when progression of the injuries and/or signs of digestive perforation or repeated bleeding are proven. In the majority of the cases a emergency blunt esophagectomy is accomplished with subsequent cervicostomy and gastro- or jejunosomy.
Yes, the treatment protocol varies with the lesion. Acute gastric bleeding may be life threatening needing immediate surgical intervention, usually partial gastrectomy. Esophagial stricture does not always need excision or bypass, dilatation with bougie after the acute stage is followed by self bouginage at home and cure many patients. The surgical treatment is reserved for the severe and extensive burns. Majority patients in our experience are females and care has been taken that the surgical technique was cosmetic without leaving ugly visible scars that will be embarrassing throughout life. Use of right colon and terminal small intestine make the conduit isoperistaltic however long the conduit is and can be done through a small incision and it is a pleasure to see the radioactive bolus passing smoothly as in normal esophagus and the girls getting married and leading a happy life. We have never seen any carcinoma developing in the injured esophagus over the last decades.