Vezakis Antonios I, Pantiora Eirini V, Kontis Elissaios A, Sakellariou Vasileios, Theodorou Dimitrios, Gkiokas Georgios, Polydorou Andreas A, Fragulidis Georgios P
2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Surgery, St Luke's Hospital, Panorama, Greece.
Am J Case Rep. 2016 May 20;17:340-6. doi: 10.12659/ajcr.897778.
Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae.
The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies.
Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.
腐蚀性物质的摄入对成人和儿童来说都是医疗急症，且与高发病率和死亡率相关。摄入腐蚀性物质后的损伤程度取决于物质的性质、数量、浓度以及接触时间。急性情况下，腐蚀性物质可能导致大量出血和胃肠道穿孔；最严重的病例需要紧急手术治疗。在初始事件中幸存的患者可能会出现主动脉-肠瘘或胃结肠瘘、食管狭窄、吞咽困难，以及作为长期后遗症的食管癌风险增加。
报告了三例腐蚀性物质摄入病例的特征，以展示在急诊科出现的显著不同的症状。两名患者出现游离性胃穿孔，一名在就诊时出现，一名延迟出现。第三名患者表现为晚期食管和幽门严重狭窄。详细讨论了这三名患者的治疗结果以及最新的管理策略。
在成人中，与儿童患者相比，由于摄入物质的量增加，腐蚀性物质的摄入通常与更严重的损伤相关。最严重的表现是内脏穿孔，最常见于胃，很少见于食管。管理包括紧急复苏，纠正液体、电解质和酸碱异常，并对有穿孔迹象的患者立即进行手术探查。一旦围手术期管理成功，长期结果可能会令人满意。狭窄或重建手术的管理必须适时进行，以利于心理和营养康复。
