Francesco Di Maggio1, Vittoria Vergani2,3, Ivan Tomasi3, Chuan Zhang2, James Gossage2, Abrie Botha2, Cara Baker2. 1. Upper Gastro-Intestinal Unit, Department of Surgery, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK. f.dimaggio@nhs.net. 2. Upper Gastro-Intestinal Unit, Department of Surgery, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK. 3. General and Emergency Surgery, Guys and St Thomas NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: Corrosive ingestion injuries are rare but clinically significant events, potentially associated with high morbidity and mortality. The low volume of cases limits guideline development. We report a 10-year experience of our tertiary centre focusing on cases requiring specialist care. METHODS: All adults treated following corrosive ingestion between 2010 and 2020 were included. Blood results, imaging and endoscopic findings were reviewed. Patients were stratified based on endoscopic findings. Emergency and delayed management was analysed along with short and long-term outcomes. Predictive value of early outcome indicators was investigated. RESULTS: Eighty-one patients were included, with an average follow-up of 5 years. Patients with injuries ≤ Zargar 2A (n = 15) had long-term outcomes similar to the ones with negative endoscopic findings (n = 51). All fifteen patients suffering injuries Zargar ≥ 2B required ITU and four died (26.6%). All deaths occurred within 50 days of ingestion, had Zargar grade ≥ 3 and airway involvement. Five patients (33%) required emergency operations, two of which died. All Zargar ≥ 2B injury survivors (n = 11) developed strictures and/or tracheo-esophageal fistulae (18%), required multiple admissions and prolonged nutritional support; five required delayed resections. Zargar grade ≥ 2B, airway damage, and increased CRP on admission correlated with unfavourable outcomes. CONCLUSION: Corrosive ingestion injuries up to Zargar 2A do not cause long-term sequelae and can be managed locally. Injuries > 2B bear high mortality and will cause sequelae. Early identification of severe injuries and transfer to specialist centres with multidisciplinary ITU, OG, thoracic and ENT expertise is recommended.
BACKGROUND: Corrosive ingestion injuries are rare but clinically significant events, potentially associated with high morbidity and mortality. The low volume of cases limits guideline development. We report a 10-year experience of our tertiary centre focusing on cases requiring specialist care. METHODS: All adults treated following corrosive ingestion between 2010 and 2020 were included. Blood results, imaging and endoscopic findings were reviewed. Patients were stratified based on endoscopic findings. Emergency and delayed management was analysed along with short and long-term outcomes. Predictive value of early outcome indicators was investigated. RESULTS: Eighty-one patients were included, with an average follow-up of 5 years. Patients with injuries ≤ Zargar 2A (n = 15) had long-term outcomes similar to the ones with negative endoscopic findings (n = 51). All fifteen patients suffering injuries Zargar ≥ 2B required ITU and four died (26.6%). All deaths occurred within 50 days of ingestion, had Zargar grade ≥ 3 and airway involvement. Five patients (33%) required emergency operations, two of which died. All Zargar ≥ 2B injury survivors (n = 11) developed strictures and/or tracheo-esophageal fistulae (18%), required multiple admissions and prolonged nutritional support; five required delayed resections. Zargar grade ≥ 2B, airway damage, and increased CRP on admission correlated with unfavourable outcomes. CONCLUSION: Corrosive ingestion injuries up to Zargar 2A do not cause long-term sequelae and can be managed locally. Injuries > 2B bear high mortality and will cause sequelae. Early identification of severe injuries and transfer to specialist centres with multidisciplinary ITU, OG, thoracic and ENT expertise is recommended.
Authors: Mircea Chirica; Michael D Kelly; Stefano Siboni; Alberto Aiolfi; Carlo Galdino Riva; Emanuele Asti; Davide Ferrari; Ari Leppäniemi; Richard P G Ten Broek; Pierre Yves Brichon; Yoram Kluger; Gustavo Pereira Fraga; Gil Frey; Nelson Adami Andreollo; Federico Coccolini; Cristina Frattini; Ernest E Moore; Osvaldo Chiara; Salomone Di Saverio; Massimo Sartelli; Dieter Weber; Luca Ansaloni; Walter Biffl; Helene Corte; Imtaz Wani; Gianluca Baiocchi; Pierre Cattan; Fausto Catena; Luigi Bonavina Journal: World J Emerg Surg Date: 2019-05-31 Impact factor: 5.469