COMBINED DUODENAL AND COLONIC NECROSIS - AN UNUSUAL SEQUELA OF CAUSTIC INGESTION

Two unusual cases of liquid caustic ingestion that resulted in gangren e of the duodenum and adjacent colon, and burns of the esophagus, stom ach, and pancreas are presented. The routine evaluation of the orophar ynx, esophagus, and stomach after liquid caustic ingestion can serious ly underestimate the extent of injury to distal portions of the gastro intestinal (Gf) tract, such as the colon and pancreas, that are not us ually included in the initial evaluation of ingestion injuries. Tn sta ble patients managed nonoperatively, the entire upper GI tract, includ ing the duodenum, must be visualized either by endoscopy or, less pref erably, by barium series. Double-contrast computed tomography should b e performed when significant duodenal injuries are present in order to inspect the colon, pancreas, and small bowel. With this approach, lif e-threatening, multi-organ, subdiaphragmatic ingestion injuries can be identified and treated early.