Tayyem Raed, Siddiqui Tamim, Musbahi Khaled, Ali Abdulmajid
Ayr Hospital, Ayr, UK.
Clin Toxicol (Phila). 2009 Aug;47(7):689-90. doi: 10.1080/15563650903095221.
We present the case of an adult who ingested soldering fluid containing zinc chloride (ZC) in a suicide attempt. He developed a gastric stricture that was managed successfully by laparoscopic Roux-en-Y gastrojejunostomy. An extensive literature review shows that there are few reports of ZC ingestion. Furthermore, management of corrosive gastrointestinal tract injury is debatable. The evidence is summarized in this case report.
ZC is a strong corrosive agent, which, following ingestion, is capable of producing widespread damage locally and systematically with long-lasting morbidity and significant mortality. The mainstay of treatment is supportive. Esophago-gastro-duodenoscopy is the diagnostic procedure of choice in the absence of perforation. Strictures that cannot be dilated endoscopically may require surgery. Emergency surgery is required for patients with evidence of perforation. Early and aggressive surgical resection in patients with high-grade burns may improve mortality and morbidity.
Because of the lack of data, it remains debatable as to the optimal management strategies following ZC ingestion. Our patient was managed conservatively throughout the acute phase. However following recognition of the gastric stricture, surgical intervention ensued and he underwent successful laparoscopic Roux-en-Y gastrojejunostomy and was subsequently discharged having made an excellent recovery.
我们报告一例成年患者，其在自杀未遂时摄入了含氯化锌（ZC）的焊剂。他出现了胃狭窄，通过腹腔镜 Roux - Y 胃空肠吻合术成功治疗。广泛的文献综述显示，关于摄入 ZC 的报道很少。此外，腐蚀性胃肠道损伤的处理存在争议。本病例报告总结了相关证据。
ZC 是一种强腐蚀剂，摄入后能够在局部和全身造成广泛损伤，导致长期发病且死亡率较高。治疗的主要方法是支持治疗。在没有穿孔的情况下，食管 - 胃 - 十二指肠镜检查是首选的诊断方法。无法通过内镜扩张的狭窄可能需要手术治疗。有穿孔证据的患者需要急诊手术。重度烧伤患者早期积极的手术切除可能会改善死亡率和发病率。
由于缺乏数据，ZC 摄入后的最佳管理策略仍存在争议。我们的患者在急性期全程采用保守治疗。然而，在发现胃狭窄后，进行了手术干预，他成功接受了腹腔镜 Roux - Y 胃空肠吻合术，随后康复良好出院。
