Stoica Alexandra, Lionte Cătălina, Palaghia Mădălina Maria, Gîrleanu Irina, Şorodoc Victoriţa, Ceasovschih Alexandr, Sîrbu Oana, Haliga Raluca Ecaterina, Bologa Cristina, Petriş Ovidiu Rusalim, Nuţu Vlad, Trofin Ana Maria, Bălan Gheorghe G, Catana Andreea Nicoleta, Coman Adorata Elena, Constantin Mihai, Puha Gabriela, Morăraşu Bianca Codrina, Şorodoc Laurenţiu
Internal Medicine Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Second Internal Medicine Clinic, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania.
J Pers Med. 2023 Jun 13;13(6):987. doi: 10.3390/jpm13060987.
Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.
尽管急性腐蚀性中毒所涉及的毒素中毒是毒理学领域中最使人衰弱的病症之一，但目前缺乏针对这些毒素的中和措施，这导致中毒发生后深部组织的渐进性接触损伤。在中毒急性期的管理策略以及患者的长期随访方面仍存在诸多争议。在此，我们报告一例硝酸故意中毒的严重病例，该病例并发上消化道广泛损伤、多处狭窄形成及完全性吞咽困难。连续的内镜扩张及空肠造口喂养管置入是必要的，且潜在的精神疾病对患者的预后产生了负面影响。我们得出结论，需要采取跨学科方法来适当减轻腐蚀所致病变及后遗症的程度。早期内镜损伤评估对于更好地预测中毒的发展及可能的并发症至关重要。介入性和重建性外科手术可显著提高腐蚀性物质中毒患者的预期寿命和生活质量。
