Search

Percutaneous endoscopic gastrojejunostomy (PEG/J) is an effective enteral nutrition tube feeding approach for upper gastrointestinal stenosis complicated with obstruction, which is a safe, convenient, efficacious and economical procedure. The intake of a strong acid will cause upper gastrointestinal tract stenosis, stomach cavity contracture deformation, and stomach position change, which brings significant challenges to PEG/J. In this article, a 63-year-old female patient suffered from severe upper gastrointestinal stricture and gastric position change caused by accidental administration of strong acid. PEG/J was performed in this patient by overcoming significant challenges. Subsequently, she successfully received enteral nutrition. This case may provide certain reference for clinicians. [ABSTRACT FROM AUTHOR]

Corrosive injuries (CI) become medical problems related complications include esophageal, pyloric stricture and squamous cell carcinoma, physical and quality of life. Endoscopic (ED) dilatation is primary therapy. The ultrathin endoscope-assisted method is potentially safe and useful in avoiding technical failure. Describe clinical outcomes of ED ED-related CI including successful, refractory, recurrent, and complications-related procedures. Case series study of esophageal and/or pyloric stricture patients after CI who underwent dilatation at Soetomo General Hospital (July 2018 – July 2022). One – biweekly ED using Through The Scope (TTS) balloon or Savary Bougie dilator. The target diameter is 14mm. Fifteen patients with stricture-related CI. Eleven patients underwent ED with a total of 73 procedures. Mean age 31,45 years, predominantly male patients (6), suicide attempt (7), acid agent (9), located at esophagus (3), pylorus (3), or both (5). Number of esophageal dilatation to achieve the target of 14 mm was 1-2 and 2-15 procedures for simple and complex stricture. Five esophageal strictures were successfully dilated but 2 patients were recurrent and 3 cases were refractory to ED. Pyloric dilatation resulted in a lower success rate. Recurrent and refractory cases were 5 and 3 patients respectively. ED with ultrathin endoscope method is useful for traversing guidewire during ED. Ongoing inflammation and fibrosis were linked to recurrent and refractory stricture.

Background: Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication. Methods: We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil). Results: Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority. Conclusion: Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial.

Background: Caustic ingestion has gained increasing attention worldwide. However, the insight into whether to use esophagogastroduodenoscopy (EGD) or computed tomography (CT) for first-line investigation remains controversial. This study aimed to evaluate a diagnostic and management algorithm that combines EGD and CT for rapid triage. Methods: We established an algorithm for our hospital in 2013, aiming to maximize the benefits and minimize the limitations of EGD and CT. Then, we retrospectively analyzed the 163 enrolled patients treated between 2014 and 2019 and categorized them into 4 groups: A = 3 (1.8%): with perforation signs and directly confirmed by CT, B = 10 (6.1%): clinically suspected perforation but not initially proven by CT, C = 91 (55.8%): initial perforation less favored but with EGD grade ≥ 2b or GI/systemic complications, and D = 59 (36.2%): clinically stable with EGD grade ≤ 2a, according to initial signs/symptoms and EGD/CT grading. The morbidity and mortality of each group were analyzed. The predictive values of EGD and CT were examined by logistic regression analyses and receiver operating characteristic (ROC) curves. Results: The outcomes of such algorithm were reported. CT was imperative for patients with toxic signs and suspected perforation. For non-emergent operations, additional EGD was safe and helpful in identifying surgical necessity. For patients with an initially low perforation risk, EGD alone sufficiently determined admission necessity. Among inpatients, EGD provided excellent discrimination for predicting the risk for signs/symptoms' deterioration. Routine additional CT was only beneficial for those with deteriorating signs/symptoms. Conclusions: According to the analyses, initial signs/symptoms help to choose EGD or CT as the first-line investigative tool in caustic patients. CT is necessary for seriously injured patients, but it cannot replace EGD for moderate/mild injuries. The severity stratification and patient categorization help to simplify complex scenarios, accelerate decision-making, and prevent unnecessary intervention/therapy. External validation in a larger sample size is further indicated for this algorithm. [ABSTRACT FROM AUTHOR]

All COVID-19 prevention strategies include regular use of surface disinfectants and hand sanitisers. As these measures took hold in Croatia, the Croatian Poison Control Centre started receiving phone calls from the general public and healthcare workers, which prompted us to investigate whether the risk of suspected/symptomatic poisonings with disinfectants and sanitisers really increased. To that end we compared their frequency and characteristics in the first half of 2019 and 2020. Cases of exposures to disinfectants doubled in the first half of 2020 (41 vs 21 cases in 2019), and exposure to sanitisers increased about nine times (46 vs 5 cases in 2019). In 2020, the most common ingredients of disinfectants and sanitisers involved in poisoning incidents were hypochlorite/glutaraldehyde, and ethanol/isopropyl alcohol, respectively. Exposures to disinfectants were recorded mostly in adults (56 %) as accidental (78 %) through ingestion or inhalation (86 %). Fortunately, most callers were asymptomatic (people called for advice because they were concerned), but nearly half reported mild gastrointestinal or respiratory irritation, and in one case severe symptoms were reported (gastrointestinal corrosive injury). Reports of exposure to hand sanitisers highlighted preschool children as the most vulnerable group. Accidental exposure through ingestion dominated, but, again, only mild symptoms (gastrointestinal or eye irritation) developed in one third of the cases. These preliminary findings, however limited, confirm that increased availability and use of disinfectants and sanitisers significantly increased the risk of poisoning, particularly in preschool children through accidental ingestion of hand sanitisers. We therefore believe that epidemiological recommendations for COVID-19 prevention should include warnings informing the general public of the risks of poisoning with surface and hand disinfectants in particular.

Background: Ingestion of alkaline substances should not be disregarded because a small amount can cause chemical burns in the esophagus, with esophageal stricture being the most common late complication.Methods: We enrolled children with alkaline corrosive damage receiving treatment at China Medical University Children's Hospital's emergency department between 2008 and 2018. Patients were divided into groups A (ingested causative agents other than alkaline oil), and B (ingested alkaline oil).Results: Altogether, 40 (27 [67.5%] male and 13 [32.5%] female) patients aged 7 months-7 years were enrolled. The most commonly ingested agent was alkaline oil (13 cases, 32.5%), followed by oven and drainage cleaners (8 cases, 20%), bleach (6 cases, 15%), laundry and dish cleaners (4 cases, 10%), sodium hydroxide (4 cases, 10%), sodium carbonate (2 cases, 5%), sodium phosphate (2 cases, 5%), and sodium citrate (1 case, 2.5%). High proportions of children had esophagitis (40/40, 100%), erosive gastritis (7/40, 17.5%), and gastric ulcer (6/40, 15%). The incidence of esophageal stricture was 38.4% (5/13) and 7.4% (2/27) in groups B and A, respectively. In group B, 4 children developed growth stunting or malnutrition during the first decade after onset, with reduced immunity and feelings of inferiority.Conclusion: Alkaline ingestion usually results in esophageal injury that is difficult to cure. Corrosive esophageal strictures cause swallowing difficulties and growth stunting in children. Young children who ingested alkaline oil have more complications. Given that alkaline corrosive injuries are often accidental, prevention of corrosive agent ingestion is crucial. [ABSTRACT FROM AUTHOR]

Abstract The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long‐term follow‐up is required for the respiratory complications of CSI.Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed.

Background: There is scarcity of data on the etiological spectrum of dysphagia from India. The study was conducted to determine the etiological spectrum of dysphagia in coastal Odisha. Materials and Methods: Consecutive patients presenting with dysphagia to the gastroenterology outpatient department in 2017 were studied. Patients were evaluated with meticulous history, clinical examination, esophagogastroduodenoscopy, and chest X-ray. Barium study and endoscopic biopsy were done when necessary. Results: Of 216 consecutive patients, 122 (56.48%) were male and 94 (43.52%) were female with a mean age of 42.3 ± 17.4 years. The common etiologies were benign stricture in 68 (31.48%) and esophageal carcinoma in 51 (23.62%). Other etiologies included achalasia cardia in 11 (5.09%), esophageal candidiasis in 10 (4.63%), pharyngeal cancer in 4 (1.85%), and esophageal web in 3 (1.39%). In 63 (29.17%) cases, no etiology was detected. Most of the benign strictures were due to corrosive injury in 48 (70.59%); other causes included peptic stricture (8, 11.76%), postsurgery (4, 5.88%), sclerotherapy-induced stricture (2, 2.94%), and pill-induced stricture (2, 2.94%); in 4 (5.88%) cases, the cause of stricture was not known. The most common cause of corrosive injury was acid injury in 38 (79.17%), followed by alkali injury in 4 (8.34%). In 6 (12.5%) cases, the nature of corrosive was not known. Most of the corrosive injuries were due to suicidal intake. Conclusion: In this study, the most common cause of dysphagia was benign corrosive stricture due to suicidal intake of corrosives. Esophageal carcinoma, achalasia cardia, and esophageal candidiasis were other significant etiologies. Uncommon causes of dysphagia included esophageal web, pharyngeal cancer, and reflux esophagitis.

All COVID-19 prevention strategies include regular use of surface disinfectants and hand sanitisers. As these measures took hold in Croatia, the Croatian Poison Control Centre started receiving phone calls from the general public and healthcare workers, which prompted us to investigate whether the risk of suspected/symptomatic poisonings with disinfectants and sanitisers really increased. To that end we compared their frequency and characteristics in the first half of 2019 and 2020. Cases of exposures to disinfectants doubled in the first half of 2020 (41 vs 21 cases in 2019), and exposure to sanitisers increased about nine times (46 vs 5 cases in 2019). In 2020, the most common ingredients of disinfectants and sanitisers involved in poisoning incidents were hypochlorite/glutaraldehyde, and ethanol/isopropyl alcohol, respectively. Exposures to disinfectants were recorded mostly in adults (56 %) as accidental (78 %) through ingestion or inhalation (86 %). Fortunately, most callers were asymptomatic (people called for advice because they were concerned), but nearly half reported mild gastrointestinal or respiratory irritation, and in one case severe symptoms were reported (gastrointestinal corrosive injury). Reports of exposure to hand sanitisers highlighted preschool children as the most vulnerable group. Accidental exposure through ingestion dominated, but, again, only mild symptoms (gastrointestinal or eye irritation) developed in one third of the cases. These preliminary findings, however limited, confirm that increased availability and use of disinfectants and sanitisers significantly increased the risk of poisoning, particularly in preschool children through accidental ingestion of hand sanitisers. We therefore believe that epidemiological recommendations for COVID-19 prevention should include warnings informing the general public of the risks of poisoning with surface and hand disinfectants in particular. [ABSTRACT FROM AUTHOR]

Corrosive injury of the upper gastrointestinal tract is a worldwide clinical problem, mostly occurring in children. Alkaline agents produce deeper injuries whereas acidic agents produce superficial injuries usually. Hoarseness, stridor, and respiratory distress indicate airway injury. Dysphagia, odynophagia, and drooling of saliva suggest esophageal injury whereas abdominal pain, nausea, and vomiting are indicative of stomach injury. X-rays should be done to rule out perforation. Endoscopy is usually recommended in the first 12–48 h although it is safe up to 96 h after caustic ingestion. Endoscopy should be performed with caution and gentle insufflation. Initial management includes getting intravenous access and replacement of fluids. Hyperemia and superficial ulcerations have excellent recovery while deeper injuries require total parenteral nutrition or feeding jejunostomy. Patients suspected of perforation should be subjected to laparotomy. Common complications after corrosive injury are esophageal stricture, gastric outlet obstruction, and development of esophageal and gastric carcinoma.

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Corrosive injuries (CI) become medical problems related complications include esophageal, pyloric stricture and squamous cell carcinoma, physical and quality of life. Endoscopic (ED) dilatation is primary therapy. The ultrathin endoscope-assisted method is potentially safe and useful in avoiding technical failure. Describe clinical outcomes of ED ED-related CI including successful, refractory, recurrent, and complications-related procedures. Case series study of esophageal and/or pyloric stricture patients after CI who underwent dilatation at Soetomo General Hospital (July 2018 - July 2022). One - biweekly ED using Through The Scope (TTS) balloon or Savary Bougie dilator. The target diameter is 14mm. Fifteen patients with stricture-related CI. Eleven patients underwent ED with a total of 73 procedures. Mean age 31,45 years, predominantly male patients (6), suicide attempt (7), acid agent (9), located at esophagus (3), pylorus (3), or both (5). Number of esophageal dilatation to achieve the target of 14 mm was 1-2 and 2-15 procedures for simple and complex stricture. Five esophageal strictures were successfully dilated but 2 patients were recurrent and 3 cases were refractory to ED. Pyloric dilatation resulted in a lower success rate. Recurrent and refractory cases were 5 and 3 patients respectively. ED with ultrathin endoscope method is useful for traversing guidewire during ED. Ongoing inflammation and fibrosis were linked to recurrent and refractory stricture.

Background: The mechanism of emamectin benzoate (EMB-a macrocyclic lactone insecticide like abamectin) action involves the disruption of glutamate-gated chloride channels and GABA receptors in insects, leading to paralysis and death. EMB overdose can breach the blood-brain barrier, resulting in severe poisoning and altered consciousness., Aim: Review EMB poisoning presentations in patients and reevaluate clinical manifestations., Materials and Methods: This retrospective study reviewed (August 31, 2008-August 31, 2023) medical university hospital records. We analyzed symptoms, patient characteristics, vital signs, Glasgow Coma Scale scores, laboratory findings, and outcomes., Results: Ten patients (males: 6, females: 4, median age = 64.5 years) experienced EMB poisoning. Common symptoms included sore throat, gastrointestinal distress, dyspnea, and altered consciousness; two patients showed laryngeal corrosive injuries. Management involved activated charcoal administration, gastric lavage, and intensive care unit admission., Discussion: Sore throat and corrosive injuries were distinctive presentations of EMB poisoning, warranting vigilance. Potential mechanisms of corrosive injury include skin and eye irritation effects of EMB, the solvents of which might exert corrosive action., Conclusion: EMB poisoning manifests as diverse symptoms, including sore throat, gastrointestinal symptoms, central nervous system depression, and potential aspiration pneumonia. Recognizing and promptly managing EMB poisoning are crucial for enhancing patient outcomes and minimizing complications., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long‐term follow‐up is required for the respiratory complications of CSI.Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed. [ABSTRACT FROM AUTHOR]

Background: There is scarcity of data on the etiological spectrum of dysphagia from India. The study was conducted to determine the etiological spectrum of dysphagia in coastal Odisha. Materials and Methods: Consecutive patients presenting with dysphagia to the gastroenterology outpatient department in 2017 were studied. Patients were evaluated with meticulous history, clinical examination, esophagogastroduodenoscopy, and chest X-ray. Barium study and endoscopic biopsy were done when necessary. Results: Of 216 consecutive patients, 122 (56.48%) were male and 94 (43.52%) were female with a mean age of 42.3 ± 17.4 years. The common etiologies were benign stricture in 68 (31.48%) and esophageal carcinoma in 51 (23.62%). Other etiologies included achalasia cardia in 11 (5.09%), esophageal candidiasis in 10 (4.63%), pharyngeal cancer in 4 (1.85%), and esophageal web in 3 (1.39%). In 63 (29.17%) cases, no etiology was detected. Most of the benign strictures were due to corrosive injury in 48 (70.59%); other causes included peptic stricture (8, 11.76%), postsurgery (4, 5.88%), sclerotherapy-induced stricture (2, 2.94%), and pill-induced stricture (2, 2.94%); in 4 (5.88%) cases, the cause of stricture was not known. The most common cause of corrosive injury was acid injury in 38 (79.17%), followed by alkali injury in 4 (8.34%). In 6 (12.5%) cases, the nature of corrosive was not known. Most of the corrosive injuries were due to suicidal intake. Conclusion: In this study, the most common cause of dysphagia was benign corrosive stricture due to suicidal intake of corrosives. Esophageal carcinoma, achalasia cardia, and esophageal candidiasis were other significant etiologies. Uncommon causes of dysphagia included esophageal web, pharyngeal cancer, and reflux esophagitis. [ABSTRACT FROM AUTHOR]

Aim: To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these. Materials and Methods: Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015. Results: Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality. Conclusion: Esophageal injuries though rare can be potentially devastating and life-threatening.

Corrosive injury of the upper gastrointestinal tract is a worldwide clinical problem, mostly occurring in children. Alkaline agents produce deeper injuries whereas acidic agents produce superficial injuries usually. Hoarseness, stridor, and respiratory distress indicate airway injury. Dysphagia, odynophagia, and drooling of saliva suggest esophageal injury whereas abdominal pain, nausea, and vomiting are indicative of stomach injury. X-rays should be done to rule out perforation. Endoscopy is usually recommended in the first 12-48 h although it is safe up to 96 h after caustic ingestion. Endoscopy should be performed with caution and gentle insufflation. Initial management includes getting intravenous access and replacement of fluids. Hyperemia and superficial ulcerations have excellent recovery while deeper injuries require total parenteral nutrition or feeding jejunostomy. Patients suspected of perforation should be subjected to laparotomy. Common complications after corrosive injury are esophageal stricture, gastric outlet obstruction, and development of esophageal and gastric carcinoma. [ABSTRACT FROM AUTHOR]

Background: Pharyngoesophageal strictures (PES) after corrosive injury impose a problematic condition for both physicians and patients in terms of their management and patients' quality of life. Colopharyngoplasty is a complex procedure, which is used to restore swallowing in these severely disabled patients. We describe our experience in treating nine patients with severe PES after corrosive injuries in a referral center. Materials and Methods: A retrospective analysis of our database from 2009 to 2014 showed nine patients (seven men; age range: 18 to 47 years) with severe PES who underwent colopharyngoplasty ~6 months (range: 4-10) after caustic material ingestion. All patients had a feeding jejunostomy tube before reconstruction. Esophagectomy with or without gastrectomy was performed in all patients, except for one; thereafter, an isoperistaltic segment of the left colon was pulled up, and a pharyngocolic anastomosis was performed. Eight patients had a tracheostomy created either before reconstruction due to respiratory symptoms or at the time of definitive surgery to prevent aspiration in the early post-operative period. Results: Almost all survivors had a satisfactory swallowing at the end of the follow-up (range: 4-60 months). The jejunostomy tube could be removed in all of the patients after a median of 5 months. One patient died of sepsis due to graft necrosis in the immediate post-operative period. Another patient died 5 months after the first surgery following a revision surgery for intractable dysphagia. At the end of the follow-up, only one patient tolerated tracheostomy tube decannulation. Two patients required laryngotracheal dissociation because of massive aspiration and recurrent episodes of pneumonia. Five patients still had a tracheostomy because of an severely destroyed larynx (two patients) and aspiration (three patients). Conclusion: Colopharyngoplasty is considered a complicated but trustworthy procedure to restore gastrointestinal tract continuity after severe corrosive injury. Undeniably, laryngeal involvement adversely affects the functional outcome. The post-operative course is frequently protracted, accompanied with several problems. Aspiration is nearly the most problematic event in the early post-operative period, which mandates a multidisciplinary approach to manage it. [ABSTRACT FROM AUTHOR]

Here, we report a case of corrosive injury-induced pharyngeal stricture in a 69-year-old female, which was successfully treated with endoscopic adhesiolysis using an electrosurgical knife. The patient had ingested sodium hydroxide in an attempted suicide, and immediate endoscopy revealed corrosive injuries of the pharynx, esophagus, and stomach. When a liquid diet was permitted, she complained of nasal regurgitation of food. Follow-up endoscopy revealed several adhesive bands and a web-like scar that did not allow passage of the endoscope into the hypopharyngeal area. For treatment of the hypopharyngeal stricture, the otolaryngologist attempted to perform an excision of the fibrous bands around the esophageal inlet using microscissors passed through an esophagoscope, but this procedure was not effective. We then dissected the mucosal adhesion and incised the adhesive bands using an electrosurgical knife. After this procedure, nasal regurgitation of food no longer occurred. To our knowledge, this case is the first report of endoscopic adhesiolysis with an electrosurgical knife in a patient with a corrosive injury-induced pharyngeal stricture.

Aim: To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these. Materials and Methods: Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015. Results: Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality. Conclusion: Esophageal injuries though rare can be potentially devastating and life-threatening. [ABSTRACT FROM AUTHOR]

Corrosive gastric injury is common in India due to easily available acids which are ingested mostly for suicide attempt. Resulting gastric outlet strictures need operation in majority of the patients. We review our experience of surgical management of these cases. Thirty-seven consecutive patients over the last 4 years with corrosive gastric strictures were reviewed. Extent of gastric cicatrisation was assessed by endoscopy and barium study. Nutrition was maintained, if necessary by feeding jejunostomy. Early definitive operation was preferred. Outcome of surgery was assessed. Patients presented with vomiting, weight loss, and dysphagia. Twenty patients (54 %) had predominant gastric corrosive injury. The oesophageal stricture in other 17 patients (46 %) could be managed easily by endoscopic dilatation. Prepyloric short gastric stricture was found in 19 patients (51 %). Surgical procedures included stricturoplasty for short strictures and gastrojejunostomy for more extensive distal gastric cicatrisation. Complications included wound infection in six (16 %) patients and pneumonitis in four (11 %) patients. All patients gained weight within 6 to 8 weeks. Management of corrosive gastric injury depends on the extent of gastric involvement, associated oesophageal stricture, and general condition of the patient. Early definitive operation and avoiding gastric resection can give satisfactory outcome. [ABSTRACT FROM AUTHOR]

Abstract We describe a case of multiple Zargar grade IIA ulcerations of the oral mucosa with no systemic toxicity in a patient after ingestion of an organophosphate. Serial debridement, control of superadded infections, and active physiotherapy were the mainstay of the treatment plan. We know of no other reported cases of poisoning by organophosphates that caused burns of the oral mucosa and no systemic toxicity. [ABSTRACT FROM AUTHOR]

Corrosive injury to upper gastrointestinal tract is a common emergency as corrosive agents are mainly products of household usage. Corrosive poisoning presents with a wide spectrum of clinical manifestations and complications. The gold standard for determination of the grade and extent of the lesion is upper gastrointestinal (UGI) Endoscopy performed in the first 24–48 hours in hemodynamically stable patients with no signs of perforation. Patients with Grade I and IIA injury are managed conservatively while patients with Grade IIB, III AND IV should be admitted in intensive care unit. Management involves maintaining ABC of resuscitation, hydration and nutritional support, proton pump inhibitors, esophageal dilatation and surgery. Inducing emesis, use of neutralising agents and placing a nasogastric tube is contraindicated. Shortterm complications include perforation, mediastinitis and death. Long-term complications include esophageal stricture, antral stricture and squamous cell carcinoma of esophagus. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding after corrosive intake is a rare complication that generally mandates a surgical intervention for control. Angioembolization for control of gastrointestinal bleeding in the setting of acute corrosive injury has not been described. Here, we present our experience of a case of acute corrosive injury presenting with massive upper gastrointestinal bleeding in the delayed phase which was successfully managed by angioembolization. We discuss the case in light of the literature available and describe markers which may serve to identify potential candidates for angioembolization. [ABSTRACT FROM AUTHOR]

Objectives: To study the pattern and endoscopic severity of caustic ingestion injuries presenting at Military Hospital Rawalpindi. Study Design: Descriptive study. Place and Duration of Study: The study was conducted at Medical and Gastroenterology Department Military Hospital Rawalpindi from August 2012 to April 2013. Material and Methods: Patients were selected from those who presented with caustic ingestion history in Medical OPD, ER and in medical wards. After informed consent the patient underwent upper gastrointestinal (GI) Endoscopy. Endoscopic findings were recorded. Results: Out of 50 patients, 21(42%) were males and 29 (58%) were females. Ingestion was accidental in 19 (38%) and was with intent of suicide or self-harm in 31(62%) patients. Mean age was 33.2 years (SD ± 13.2). All the patients were subjected to upper GI endoscopy and findings were recorded. Endoscopic findings were grade 0 in 4 (8%), Grade 1 in 6 (12%), grade 2a in 7 (14%), grade 2b in 10 (20%), grade 3a in 6 (12%) and grade 3b in 17 (34%) patients. Conclusion: Caustic ingestion injuries were seen more in younger females with predominant cause as suicidal intent. On endoscopic examination severe corrosive injuries were more frequent. [ABSTRACT FROM AUTHOR]

Caustic ingestion continues to be a significant problem world-wide especially in developing countries and particularly in the under 6 years age group. The presence or absence of symptoms or oral lesions does not reliably predict the existence or severity of oesophageal lesions. Upper endoscopy remains the mainstay diagnostic modality for evaluation to define the extent and severity of the injury. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Early management strategies for caustic ingestion are well defined. Controversy still surrounds the use of steroids, antibiotics, antacid therapy in the acute phase, and the use of oesophageal stents and the frequency, timing and method of dilatation in the prevention and management of oesophageal strictures. There is a pressing need for non-invasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion. Indications for definitive surgery or bypass and the type of procedure to use are also subject to ongoing debate. [ABSTRACT FROM AUTHOR]

Isolation of a diseased esophagus with surgical bypass is an acceptable treatment option[1-5] performed for various benign and malignant conditions affecting the esophagus with excellent outcome observed in patients following corrosive injury. There may be continued production of mucosal secretions within the native esophagus which gets retained and forms a mucocele. It is uncommon for a mucocele to develop in an esophagus sustaining caustic injury as the epithelium responsible for mucous production is also destroyed. These mucoceles are usually small and localized to a segment and remain asymptomatic without need of any surgical intervention. We herein present a case of middle aged female who underwent esophageal replacement for corrosive ingestion and now presented with chest pain two years after the surgery secondary to a huge mucocele involving the entire native esophagus. [ABSTRACT FROM AUTHOR]