Corrosion injury of the upper gastrointestinal tract after swallowing strong alkali

Abstract

Objective: To review our experience of 9 patients who had attempted suicide by swallowing alkaline substances. Design: Retrospective study. Setting: Two university hospitals, Finland. Patients: During the years 1987- 1996. 9 patients who had swallowed more than 100 ml of strong alkali. Results: 2 patients with oesophagorespiratory fistulas of the four with third degree injuries died in hospital, the first died of overwhelming sepsis and the second of multiple organ failure. The other two survived emergency staged resection and subsequent reconstruction. Delay between swallowing the alkali and the initial operation, and development of oesophagorespiratory fistulas were the most important predictors of death. Four patients with second degree injuries underwent oesophageal resection and reconstruction after they had developed oesophageal strictures. Two of these six survivors developed anastomotic strictures after reconstruction, both of which necessitated repeated oesophageal dilatations. One patient with a first degree injury v as treated conservatively. Conclusions: An early and aggressive approach to severe third degree corrosive injuries of the upper gastrointestinal tract is needed to resect all necrotic tissue and to make it possible to do a successful reconstruction later. The development of oesophagorespiratory fistulas requires immediate attention, whereas first and second degree injuries can be treated after the patient has been stabilized.