UPPER GASTROINTESTINAL-TRACT ABLATION FOR PATIENTS WITH EXTENSIVE INJURY AFTER INGESTION OF STRONG ACID

Objective: Extensive corrosive injury involving the structures beyond the pylorus caused by ingestion of strong acid has a poor prognosis. W e reviewed six cases of patients who underwent total upper gastrointes tinal tract ablation to see the effect of this extensive procedure for such an injury. Design: Case series. Setting: Tertiary care center. P atients: Six patients who ingested more than 250 mt of 20N hydrochlori c acid were treated in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China, from 1986 to 1992. Result s: Three patients with preoperative metabolic acidosis and renal failu re died of multiple organ failure within the first postoperative month . The other three patients survived the acute stage. While being readi ed for a late reconstructive procedure, sepsis developed in one patien t due to cholecystostomy leakage about 1 year postoperatively. Another patient died of respiratory failure after development of aspiration p neumonia due to poor drainage of a spit fistula, after surviving for 6 months. Only one patient had a good recovery following a full reconst ruction procedure and restoration of the continuity of the gastrointes tinal tract. Conclusions: Three of six patients died in the hospital. The risk factors were preoperative metabolic acidosis, renal failure, and an upper jejunal resection greater than 100 cm in length. Early an d aggressive approaches to resect all the necrotic tissue certainly pr ovide good chances to survive the acute stage and later reconstruction .