Department of Radiodiagnosis All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029.
Br J Radiol. 2020 Oct 1;93(1114):20200528. doi: 10.1259/bjr.20200528. Epub 2020 Jul 24.
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.
腐蚀性损伤是一种严重的损伤,会导致显著的发病率。上消化道是主要受影响的部位,严重程度从轻度炎症到全层坏死不等,可能导致穿孔和死亡。在并发症中,最常见的是狭窄形成,导致吞咽困难和营养不良。内镜检查在诊断和治疗中起着关键作用,但也存在一些缺点。影像学在其中也发挥着重要作用。除了 X 线摄影外,在急诊情况下,CT 扫描在识别可能受益于手术的患者方面具有较高的准确性,其作用也越来越重要。此外,CT 扫描在并发症的诊断中也具有一定的作用。口服造影剂检查有助于评估亚急性和慢性阶段狭窄形成的严重程度和范围,以及相关的瘘管并发症。介入放射学在这种情况下的治疗范围正在扩大。透视引导下球囊扩张、积液或黏液囊肿引流、点状出血的血管内栓塞、肠内营养造口术和影像学引导下活检等都是正在进行的治疗方法。通过本次综述,我们旨在强调放射科医生在这些患者的诊断和随访以及进行放射学干预中的作用。此外,我们还强调了一些要点,以帮助理解这种损伤的病理生理学和管理,这对于确保良好的长期预后至关重要。