A STUDY OF CORROSIVE INJURY OF UPPER GASTROINTESTINAL TRACT- STUDY OF SURGICAL ASPECTS OF ACUTE STAGE AND ITS SEQUELAE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 19
Abstract
BACKGROUND Corrosive injury to upper gastrointestinal tract is an agonizing experience for both patient and treating physician. Though formulations of household cleansing agents have become safer in recent times, corrosive injury still remains common clinical problem in many countries particularly India. Lye is most commonly ingested caustic in west. Acid ingestion is a commoner cause of upper gastrointestinal tract injury in our country. Childhood injuries are usually accidental while suicide is frequent motive in young adults. METHODS This is a prospective observational study. All the patients who presented to the Emergency Department or OPD in M.Y. hospital with history of Corrosive Agent Ingestion from Year March 2016 to July 2017 were included in the study. RESULTS In our study, the most common symptom is dysphagia which was present in 95% (59/62), chest pain 65% (40/62), vomiting 47% (29/62), abdominal pain 15% (9/62), drooling of secretions 60% (37/62), Hematemesis 10% (6/62). The site of lesion is predominantly oesophagus with 23% mid oesophagus (14/62), 19% distal oesophagus (11/62), 23% involving both mid and distal oesophagus (14/62), stomach 16% (10/62) and single case involving duodenum. Seven out of 62 patients presented to us with signs of acute abdomen with X-ray abdomen revealing gas under diaphragm. Three patients after adequate resuscitation were taken for exploratory laparotomy. Remaining four patients succumbed to resuscitation. 27% (16/62) had severe oesophageal injury. In our study, oesophageal stricture was present in 75% cases (46/62), gastric outlet obstruction in 16% cases (10/62), epigastric pain due to GERD in 20% cases (12/62). CONCLUSIONS Corrosive injury of the upper gastrointestinal tract is a common problem with variable clinical presentations. Acid injury is more common in developing countries like India. The depth of injury is the most important determinant of the outcome. Early endoscopy is helpful in assessing the extent of injury to plan future management of the patient. Nutritional support is given by total parenteral nutrition and feeding jejunostomy. Nasogastric tube and antibiotics have no role in preventing stricture. Endoscopic dilatation is the treatment of choice for oesophageal stricture. Surgery remains the last option for endoscopic failure and for patients who develop complications on endoscopic dilatation.
Authors and Affiliations
Abhineet Kumar Jain, Dinesh Chaudhari, Geetesh Ratre
Keywords
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- EP ID EP617643
- DOI 10.14260/jemds/2019/350
- Views 88
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