Scriba Matthias Frank, Jonas Eduard, Chinnery Galya Eileen
Department of Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa.
World J Gastrointest Pharmacol Ther. 2024 Nov 5;15(6):99097. doi: 10.4292/wjgpt.v15.i6.99097.
Corrosive ingestion remains an important global pathology with high morbidity and mortality. Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce, with international investigative algorithms, relying heavily on computed tomography (CT), having limited availability in this setting.
To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness (FT) necrosis and mortality.
A retrospective analysis of a prospective corrosive injury registry (March 1, 2017-October 31, 2023) was performed to include all adult patients with acute corrosive ingestion managed at a single, academic referral centre in Cape Town, South Africa. Patient demographics, corrosive ingestion details, initial investigations, management, and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs (ROC AUC) were used to identify factors predictive of FT necrosis and 30-day mortality.
One-hundred patients were included, with a mean age of 32 years (SD: 11.2 years) and a male predominance (65.0%). The majority (73.0%) were intentional suicide attempts. Endoscopy on admission was the most frequent initial investigation performed (95 patients), while only 17 were assessed with CT. Seventeen patients had full thickness necrosis at surgery, of which eleven underwent emergency resection and six were palliated. Thirty-day morbidity and mortality were 27.0% and 14.0%, respectively. Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8% and 91.0%, respectively. Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%. Multivariate analyses with ROC AUC showed admission endoscopy findings, CT findings, and blood gas findings (pH, base excess, lactate), to all have significant predictive value for full thickness necrosis, with endoscopy proving to have the best predictive value (AUC 0.850). CT and endoscopy findings were the only factors predictive of early mortality, with CT performing better than endoscopy (AUC 0.798 0.759).
Intentional corrosive injuries result in devastating morbidity and mortality. Locally, early endoscopy remains the mainstay of severity assessment, but referral for CT imaging should be considered especially when blood gas findings are abnormal.
腐蚀性物质摄入仍然是一种重要的全球性病理状况，发病率和死亡率都很高。关于撒哈拉以南非洲地区成人腐蚀性损伤急性处理的数据很少，而严重依赖计算机断层扫描（CT）的国际调查算法在这种情况下的可用性有限。
研究资源匮乏环境下的腐蚀性损伤谱，以及预测全层（FT）坏死和死亡率的参数的适用性。
对一个前瞻性腐蚀性损伤登记处（2017年3月1日至2023年10月31日）进行回顾性分析，纳入在南非开普敦一家学术转诊中心接受治疗的所有成年急性腐蚀性物质摄入患者。使用描述性统计描述患者的人口统计学特征、腐蚀性物质摄入细节、初始检查、治疗和短期结果，同时使用曲线下面积接受者操作特征图（ROC AUC）进行多变量分析，以确定预测FT坏死和30天死亡率的因素。
纳入100例患者，平均年龄32岁（标准差：11.2岁），男性占多数（65.0%）。大多数（73.0%）是故意自杀未遂。入院时进行内镜检查是最常见的初始检查（95例患者），而只有17例接受了CT评估。17例患者在手术时出现全层坏死，其中11例接受了急诊切除，6例接受了姑息治疗。30天发病率和死亡率分别为27.0%和14.0%。全层坏死患者和已确诊穿孔患者的30天死亡率分别为58.8%和91.0%。全层坏死与仅17.6%的2年累积生存率相关。使用ROC AUC进行的多变量分析显示，入院内镜检查结果、CT检查结果和血气检查结果（pH值、碱剩余、乳酸）对全层坏死均具有显著预测价值，其中内镜检查显示具有最佳预测价值（AUC 0.850）。CT和内镜检查结果是预测早期死亡率的唯一因素，CT的表现优于内镜检查（AUC 0.798对0.759）。
故意腐蚀性损伤会导致毁灭性的发病率和死亡率。在当地，早期内镜检查仍然是严重程度评估的主要方法，但应考虑转诊进行CT成像，尤其是当血气检查结果异常时。
