Alfaro-Pacheco R, Brenes-Barrantes R, Juantá-Castro J, Rojas-Chaves S, Echeverri-McCandless A, Brenes-Barquero P
Servicio de Cirugía de Tórax, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica.
Servicio de Cirugía de Tórax, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, Costa Rica.
Int J Surg Case Rep. 2023 May;106:108293. doi: 10.1016/j.ijscr.2023.108293. Epub 2023 May 6.
Caustic or corrosive substance ingestion that results in severe esophageal and gastric lacerations frequently requires surgical management. The most common sequelae after an upper gastrointestinal tract caustic injury include non-responding luminal strictures, which are subject to esophageal replacement. Late corrective surgery may include esophagectomy with gastric pull-up and jejunal or colonic interpositions. Although long-segment esophageal reconstruction with jejunum is technically feasible and has demonstrated good outcomes, the complexity of the surgery has precluded the widespread use of this procedure in low- and middle-income countries. This document summarizes the most relevant aspects of caustic ingestion surgical management and describes the first Latin American experience in the reconstruction of an esophageal-gastric caustic injury using a pedicled jejunal interposition, as a viable and functional option in mid- and lower-income countries with well-established Thoracic Surgery departments and microsurgery access.
摄入苛性或腐蚀性物质导致严重的食管和胃撕裂伤时，通常需要手术治疗。上消化道腐蚀性损伤后最常见的后遗症包括无反应性管腔狭窄，需要进行食管置换。晚期矫正手术可能包括食管切除术加胃上提术以及空肠或结肠间置术。尽管用空肠进行长段食管重建在技术上是可行的，并且已显示出良好的效果，但手术的复杂性使得该手术在低收入和中等收入国家无法广泛应用。本文总结了腐蚀性物质摄入手术治疗的最相关方面，并描述了拉丁美洲首次使用带蒂空肠间置术重建食管-胃腐蚀性损伤的经验，这是在拥有成熟胸外科部门和显微外科技术的低收入和中等收入国家一种可行且有效的选择。
