Massive necrosis of the gastrointestinal tract after ingestion of hydrochloric acid

Objective. To describe our experience of dealing with patients admitted as emergencies after massive ingestion of hydrochloric acid, and to find out t he most important prognostic factors. Design: Retrospective review. Setting: Teaching hospital, Spain. Subjects: 21 patients with massive necrosis of the upper gastrointestinal t ract after ingestion of acid who presented during the past 14 years (Novemb er 1984-March 1998). Interventions: All patients were operated on immediately, 17 without an end oscopic examination. In all cases, the laparotomy showed various degrees of damage to the intra-abdominal oesophagus (from oedema to blackening) and g astric necrosis. Twelve patients also had necrosis of the entire duodenum. In the other nine, the necrosis did not affect more than the pylorus or duo denum. All these 12 patients were treated by a total oesophago-gastrectomy without thoracotomy. Of the 12 patients with total necrosis of the duodenum , 4 did not have resections and in 8, various massive resections of the nec rotic structures were done. Main outcome measures: Mortality. Results: Fourteen of the 21 patients died during the operation or in the ea rly or late postoperative period. All 12 patients with total duodenal necro sis died, whereas only 2 patients in the other group. Conclusions: The ingestion of relatively small amounts of water-based solut ions of hydrochloric acid of 24% or 32% concentration produces immediate an d massive necrosis of the upper digestive tract, which results in high mort ality. The poor prognosis might be improved by rapid responses to stop duod enal necrosis.