EMERGENCY MANAGEMENT OF CAUSTIC INGESTION IN ADULTS

A study of 57 patients admitted to the Department of Emergency Surgery at the Ospedale Maggiore in Milan between 1980 and 1992 following the recent ingestion of a caustic substance is presented herein. Through this study, an aggressive diagnostic and therapeutic approach has been employed, including early surgery which plays a fundamental role in t he prevention of acute hemorrhagic or perforative complications as wel l as in the development of scar tissue and neoplastic strictures over time. The criteria for early emergency surgery were the presence of en doscopic grade 3 and 4 lesions as well as those on the borderline betw een grades 2 and 3 with clinical symptoms. In 11 patients with lesions of moderate severity, the treatment of choice was medical therapy, wh ich required subsequent surgical intervention for strictures in 5 pati ents. In 13 patients with severe lesions, an early surgical approach w as performed with a mortality rate of 23%.