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Long-Bin Benjamin Jeng, MD; Hoang-Yang Chen, MD; Shin-Cheh Chen, MD; Tsann-Long Hwang, MD; Yi-Yin Jan, MD; Chia-Siu Wang, MD; Miin-Fu Chen, MD

Arch Surg. 1994;129(10):1086-1090.

Abstract
Objective
Extensive corrosive injury involving the structures beyond the pylorus caused by ingestion of strong acid has a poor prognosis. We reviewed six cases of patients who underwent total upper gastrointestinal tract ablation to see the effect of this extensive procedure for such an injury.

Design
Case series.

Setting
Tertiary care center.

Patients
Six patients who ingested more than 250 mL of 20N hydrochloric acid were treated in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China, from 1986 to 1992.

Results
Three patients with preoperative metabolic acidosis and renal failure died of multiple organ failure within the first postoperative month. The other three patients survived the acute stage. While being readied for a late reconstructive procedure, sepsis developed in one patient due to cholecystostomy leakage about 1 year postoperatively. Another patient died of respiratory failure after development of aspiration pneumonia due to poor drainage of a spit fistula, after surviving for 6 months. Only one patient had a good recovery following a full reconstruction procedure and restoration of the continuity of the gastrointestinal 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 and aggressive approaches to resect all the necrotic tissue certainly provide good chances to survive the acute stage and later reconstruction.

(Arch Surg. 1994;129:1086-1090)

Author Affiliations
From the Department of Surgery, Chang Gung Medical College, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

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