Corrosive Ingestion Research Articles

133 SURGICAL MANAGEMENT OF ESOPHAGEAL STENOSIS DUE TO CORROSIVE SUBSTANCES

Abstract Corrosive ingestion is a significant challenge for healthcare support. Limited data is available regarding the best treatment, and there is still a lack of consensus about the optimal surgical approach and its outcomes. This study aims to show a single-institution experience of surgical treatment of esophageal stenosis due to corrosive substance ingestion and review the current literature. Methods A retrospective review, including demographics, psychiatric profile, surgical procedures, and outcomes, is described. A systematic review of the literature was performed in PubMed. Results In total, 27 surgical procedures for esophageal stenosis due to corrosive substances ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. The incidence rate of cancer in patients with corrosive esophageal stenosis is 701.7–874.1 per 1,000,000 person-years, and the cancer latency between corrosion ingestion to carcinoma is 10–58 years. Esophagectomy and esophageal bypass were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. Conclusion The surgical intervention either by esophagectomy or esophageal bypass seems to show a high success rate. However, the outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.

Acid corrosive injury of stomach: management and long-term outcome

Background: Acid corrosive injury to stomach is not uncommon in India due to easy availability. Corrosive ingestion results in significant morbidity. We present our experience in surgical management of such cases. The aims and objectives of this study to review the experience of surgical management of gastric corrosive injury and to assess long term outcome and functional results.Methods: This study was retrospective analysis of prospectively collected data of 23 cases of acid corrosive injury managed in a single surgical unit.Results: Median age was 31 years, male to female ratio was 12:11. Surgical procedures were tailored according to extent and degree of stricture. Posterior gastrojejunostomy was done in 8 (38.0%) cases, near total gastrectomy in 3 (14.3%) cases, total gastrectomy and Billroth I in 2 (9.5%) cases each. 4 cases were lost to follow up after preliminary feeding jejunostomy. 2 cases had mortality after feeding jejunostomy. 2 cases were managed successfully without active surgical intervention. All patients undergoing definitive procedure had good results in terms of nutritional status and symptoms of gastric outlet obstruction.Conclusions: The outcome of gastric stricture secondary to acid ingestion can be significantly improved by adequate preoperative preparation and planned approach depending upon type of injury.

MON-688 Emphysematous Gastritis and Diabetes

Background: Emphysematous gastritis (EG) is a rare and severe form of gastritis of infectious origin. Diabetes is an important underlying risk factor as it leads to a systemic predisposition to infections. Other risk factors include long term steroid use, nonsteroidal anti-inflammatory (NSAID) use, alcohol use, corrosive ingestion, and pancreatitis, all of which disrupt gastric mucosa. First described in the 1800s, it is characterized by the presence of air in the stomach wall and differentials for these cases include gastric emphysema and cystic pneumatosis both of which are non-infectious in origin. Clinical Case: A 57-year-old male with type 2 diabetes presented with a one-day history of abdominal pain, non-bloody diarrhea, and vomiting. One day prior to presentation, he developed diarrhea which was followed by episodes of projectile vomiting reported as orange-tinged with mucus. On the day of admission, he was afebrile, tachycardic in 120s with stable blood pressure. Laboratory evaluation was significant for leukocytosis at 18.8 k/uL (4.3–11.3 k/uL) and lactic acidosis 2.37 mmol/L (0.7–2.1 mmol/L). Abdominal examination was notable for soft abdomen with diffuse tenderness to deep palpation without rebound or guarding. Further workup with Computed Tomography (CT) was concerning for emphysematous gastritis with air in the gastric vein, splenic vein, and portal vein. Given hemodynamic stability and benign abdominal examination, medical management was initiated. He was started on ceftriaxone and metronidazole which were continued for a total of 10 days with clinical improvement. Discussion: EG results from disruption in gastric mucosa which facilitates translocation of gas-producing bacteria commonly Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa, and Enterobacter subspecies. Immunosuppression with diabetes is an important underlying factor and patients are at risk even with controlled diabetes. Additionally, patients with diabetic complications like gastroparesis with frequent retching are at increased risk. Considering variable and non-specific symptoms of presentation, a high index of clinical suspicion is required for recognition as it may have a fulminant course with high mortality risk. CT scan is the imaging of choice for diagnosis. Management primarily consists of bowel rest, antibiotics and monitoring for signs of peritonitis. In the absence of complications including rupture or stricture formation, surgery is not recommended. In our case, possible gastroenteritis with subsequent vomiting and retching in the setting of underlying diabetes predisposed to the development of emphysematous gastritis. Although air in the portal venous system is associated with higher mortality, our patient was successfully managed conservatively. As the diagnosis carries a high mortality risk, early recognition is imperative for a successful outcome.

Corrosive ingestion managements in children

Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.

Corticosteroid injection of impassable caustic esophageal strictures without dilatation: Does it pave the way to interval endoscopic dilatation?

Background/PurposeEndoscopic dilatation of caustic esophageal stricture is the mainstay of therapy. The need for esophageal replacement has decreased over the past decades owing to advancement in techniques of dilatation. In this study, we aimed to assess our results of four-quadrant corticosteroid injection of impassable caustic esophageal strictures followed by a trial endoscopic dilatation. MethodsDuring the period from June 2003 to May 2017, in 340 patients in whom a trial of endoscopic dilatation after corrosive ingestion failed, corticosteroid was injected in 4 quadrants at the site of the stricture in the same setting. After 2 weeks, another trial of endoscopic dilatation was done. ResultsOut of the 340 patients with failed first trial of endoscopic dilatation followed by four-quadrant corticosteroid injection, the second trial of endoscopic dilatation, after 2 weeks, was possible in 255 patients (75%). In the remaining 85 patients (25%), the endoscope could not pass and they were candidate for esophageal replacement. ConclusionsFour-quadrant corticosteroid injection of impassable caustic esophageal stricture followed by endoscopic dilatation is a minor procedure which decreased the need of a major procedure to replace the injured esophagus. Type of the studyClinical research paper. Level of evidenceLevel III.

Factors affecting the outcome of endoscopic dilatation in refractory post-corrosive oesophageal stricture in Egyptian children: a single-centre study.

An important complication of corrosive ingestion is oesophageal stricture. Improvements in endoscopes and accessories have supported an increase in the number of patients who are conservatively treated with endoscopic dilations. In this study, we aimed to detect factors affecting the outcome of endoscopic dilatation for refractory post-corrosive oesophageal stricture. This study was carried out in the Paediatric Endoscopy Unit in the Children's Hospital and included 100 children older than 2years of age of both sexes who had an established diagnosis of post-corrosive oesophageal stricture on repeated endoscopic dilatation sessions. The duration of the condition was more than 6months, and dilatation failed to achieve a diameter of 14mm during the first five sessions at 2-week intervals (refractory), excluding other causes of oesophageal stricture. Males represented 63% of patients. The mean age of enrolled children was 5.9 ± 2.6years; 90% of patients ingested an alkaline corrosive substance (potash). The total number of dilatation sessions ranged from 16 to 100, with a mean number of sessions ranging from 37.2 ± 14.9. Fifty-four patients (54%) were well controlled by regular endoscopic dilatation with good clinical and endoscopic outcomes, and no more dilatations were needed. Endoscopic dilation is an effective method for managing refractory post-corrosive oesophageal strictures that require a long follow-up period. There are a lot of factors affecting the outcome.

A Common Toxicologic Emergency: Caustic and Corrosive Ingestions in Children Presenting to the Emergency Department

A Common Toxicologic Emergency: Caustic and Corrosive Ingestions in Children Presenting to the Emergency Department

Management of tracheal stenosis after corrosive acid ingestion: Case report

Although corrosive injury of the digestive tract is a well-known clinical entity, damages of the airway and a critically life-threatening condition, have not been clearly documented. Tracheal stenosis is very rare associated with corrosive acid ingestion. We report the case of a 4-year-old girl child who presented to the emergency department three weeks after accidentally drinking an acidic cleaning agent stored in an unlabeled bottle. Rigid bronchoscopy was administered to observe the stenosis. She was treated by serial dilation, repair of tracheal laceration, and placement of a temporary polyurethane-coated nitinol stent. Careful and accurate stent placement may provide significant and life-saving airway improvement as observed in the presenting pediatric case.

Presentation and management outcome of childhood corrosive oesophageal injury in Benin City.

Background:Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes.Aims and Objectives:This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018.Materials and Methods:This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and studied for epidemiological, clinical and operative procedures and outcome.Results:A total of 49 patients were seen and admitted during the period under review. Male (29) : Female (20) ratio was 1:1.4 Mean age was 4.7±4.8 years with a range of 1-16years, The males presented earlier and had worse strictures as well as more surgical procedures. Caustic soda preparations ingested more (93.9%), all ingestions were within the household setting, and all had first aid given by way of oral palm oil. Only two (4.1%) ingested acids with only one flat battery ingestion. 45.5% of the patients had dilatation only and of these 50% recovered after 3 sessions and required no more sessions. A further 50% were lost to follow up. 38.8% had oesophageal replacement with colon following oesophagectomy.Conclusion:In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.

Ingestion of hydrochloric acid in adults

Corrosive ingestion is more commun in the pediatric population(mostly accidents), but adults are also concerned(suicide) with more severe lesions. Massive ingestion of corrosive agents results in severe upper gastrointestinal and oropharyngeal tract injuries requiring multidisciplinary management. The endoscopy is systematic,the gastro-intestinal endoscopy must be conducted under sedation, with minimal insufflation, between 6 to 24 hours after ingestion. Endoscopic injuries must be described according to the Zargar or the Di-Costanzo classification. We report a case describing an ingestion of a strong acid. A 52-year-old woman, with no medical history specially psychiatric illness, was admitted to the emergency room for the voluntary ingestion of half a glass of hydrochloric acid for autolytic purposes after family problems. The patient was admitted to intensive care, she presented with a cough, hypersiallorhea, with epigastralgia, a thoracoabdominal Computed tomography (CT) was conducted and objected a circumferential parietal thickening of the gastric wall in relation with post caustic ulcerative oedematous lesions. Twelve hours later, the esophagogastroduodenoscopy was performed and found a stage I esophagitis, a stage IIIA gastritis according to Di Costanzo (A,B). The medical treatment intaured: digestive rest, proton pump inhibitor and parenteral nutrition. The first endoscopic check was made after a week and showed an improvement in the endoscopic lesions: normal esophagus, fundic gastritis stage IIB and antral gastritis stage IIA according to the classification of Di-Costanzo. Psychiatric follow-up has been instituted. The evolution was favourable, the third endoscopic control after 2 weeks showed the healing of the lesions: antral gastritis stage IIA(C), Fundic gastritis stage I(D) of Di-Costanzo.

Study of the medium term outcome in corrosive upper gastrointestinal strictures managed in one unit by combined endoscopic and surgical modalities

Background: Corrosive substances can cause serious injuries of the upper gastrointestinal tract and may lead to death. Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are mostly used as household agents and are ingested accidentally or suicidal intentionally. The objectives of the present study were to evaluate and compare the medium term outcomes of the multi modal treatment used for patients presenting with corrosive upper gastrointestinal strictures and to study the demographic and clinico- pathological profile of the patients of corrosive upper gastro intestinal tract strictures.Methods: A combined retrospective and prospective study was carried out on departmental database and patient presenting with corrosive upper gastrointestinal stricture from December 2010 to July 2019 in the Department of Surgical Gastroenterology at King George's Medical University for a period of 9 years.Results: Corrosive ingestion was found to be more prevalent in age group of 15-65 years with higher incidence to be found in females compared to males. Majority of ingestion of corrosive substances are found to be suicidal by adults.Conclusions: India has high incidence of corrosive ingestion mainly suicidal and homicidal indent. Endoscopic dilatation of esophageal strictures is safe and effective therapy and should be first line therapy in patients with esophageal strictures and surgery should be considered only in patients who have technical and clinical failure on endoscopic dilatation.

RETROSPECTIVE AND PROSPECTIVE STUDY OF CORROSIVE POISONING AND ITS EFFECT ON UPPER GASTRO INTESTINAL TRACT AND SURGICAL MANAGEMENT IN TERTIARY CARE CENTRE

Background: Corrosive injury to the upper gastrointestinal tract is an insufferable experience for both the patient and surgeon. Corrosive ingestion may usually responsible for wide spread injury to the lips, oral cavity, oropharynx and the upper air way, upper gastrointestinal tract.
 Results: in our study more common patients were in the age group 21-30 years. Majority of the patients had consumed toilet cleaner. Majority of the patients had consumed substance of <=30 ml. Majority of the patients had consumed HCL. Majority of the patients had consumed the substance with a suicidal Intention, [ 42.9%] consumed corrosive under influence of alcohol, In 5 (14.3%) patients had oropharynx involvement, in 8 (22.9%) patients had lower esophagus involvement, in 8 (22.9%) patients had middle esophagus involvement and 17 (48.6%) patients had upper esophagus involvement. In 18 (51.4%) patients had pylorus (stomach) involvement and in 5 (14.3%) patients duodenum (first part) involvement. In 11 (31.4%) patients esophagus was involved at 2A level, in 17 (48.6%) patients esophagus was involved at 2B level and in 2 (5.7%) patients esophagus was involved at 3A level. In 9 (26.5%) patients dilatation was not possible, in 2 (5.9%) patients it was not done. In 9 (26.5%) dilatation was done 2 times and in 14 (41.1%) patients dilatation was done 3 times .In 34 (97.1%) patients feeding jejunostomy insertion was done in 1 (2.9%),most common sequels esophageal stricture [65.7%] and GOO[40%], patient laparotomy Bilroth II gastrectomy was done as a primary intervention. Majority of the patients complained of dysphagia and chest pain and cough at first visit. In 11 (32.4%) patients gastrojejunostomy was done, in 7 (20.6%) patients esophagectomy with gastric pull-up was done, in 4 (11.8%) patient’s thoracoscopic esophagectomy with colonic interposition was done. There were 3 (8.6%) deaths and 32 (91.4%) patients were discharged successfully in our study there was a significant improvement seen in the weight from follow-up at 2 months till the end of follow-up at 12 months (p<0.05).
 Conclusion: In our study corrosive ingestion common in young age decrees, with increase age, (HCL) toilet cleaner found to be the commonest corrosive chemical used esophags most common than pylorus affected by the ingestion, oropharynx and duodenum less likely,2Bgrade of injury was affected the most in esophagus, stomach or duodenum, with a very high incidence of stricture formation. Dysphagia, throatpain, excessive salivation and hoarseness of voice were the commonest presenting symptoms. The first line of performed surgery at presentation was insertion of feeding jejunostomy and improvement in diet intake and strength of feeding jejunotomy patients underwent gastrojejunostomy, esophagectomy with gastric pull-up or thoracoscopic esophagectomy with colonic interposition. Dilatation was required in majority of the patients. There was a significant improvement in the weight of these patients over various follow-up periods. The overall success rate of management of these patients was found to be very high with only a very few deaths recorded in our study.
 Keywords: Corrosive injury, Esophagealstricture, Gastric outlet obstruction, Upper GI endoscopy.

Retrospective Evaluation of Corrosive Substance Ingestion: Single Center Experience

Retrospective Evaluation of Corrosive Substance Ingestion: Single Center Experience

Role of Speech-Language Pathologist in Pediatric Corrosive Ingestion in Zagazig University Children Hospital

Background: Pediatric corrosive ingestion injuries represent a significant proportion of total ingestion injury annually. Medical and surgical advancements over the past five decades led to significant reductions in mortality. Optimal treatment of children with ingestion injuries requires a multi-skilled team approach. Objective: The aim of the work was to assess the effects of corrosive ingestion in children and to determine the role of speech-language pathologist. Patients and methods: This cross section study was conducted on 52 patients with corrosive ingestion. The patients were admitted at Zagazig University Children Hospitals from February 2018 to February 2019. Results: Our results showed that there was high significant relation between impaired oral intake and period of admission, PICU admission, days to initiate oral feeding and grade of mucosal injury. Also, there was high significant relation between fluid, semisolid and solid dysphagia and oropharyngeal mucosal injury. Also, there was a high significant relation between oesphageal mucosa grading of injury and oropharyngeal mucosal injury. Conclusion: Children admitted to hospital with severe ingestion injury to the oral cavity, oropharynx and esophagus had significant and sustained delay in the recovery of effective PO intake milestones, with many requiring ongoing gavage feeding at hospital discharge.

Role of Speech-Language Pathologist in Pediatric Corrosive Ingestion in Zagazig University Children Hospital

Background: Pediatric corrosive ingestion injuries represent a significant proportion of total ingestion injury annually. Medical and surgical advancements over the past five decades led to significant reductions in mortality. Optimal treatment of children with ingestion injuries requires a multi-skilled team approach. Objective: The aim of the work was to assess the effects of corrosive ingestion in children and to determine the role of speech-language pathologist. Patients and methods: This cross section study was conducted on 52 patients with corrosive ingestion. The patients were admitted at Zagazig University Children Hospitals from February 2018 to February 2019. Results: Our results showed that there was high significant relation between impaired oral intake and period of admission, PICU admission, days to initiate oral feeding and grade of mucosal injury. Also, there was high significant relation between fluid, semisolid and solid dysphagia and oropharyngeal mucosal injury. Also, there was a high significant relation between oesphageal mucosa grading of injury and oropharyngeal mucosal injury. Conclusion: Children admitted to hospital with severe ingestion injury to the oral cavity, oropharynx and esophagus had significant and sustained delay in the recovery of effective PO intake milestones, with many requiring ongoing gavage feeding at hospital discharge.

1787 Esophageal Stricture in Pregnancy Secondary to Stevens-Johnson Syndrome

INTRODUCTION: Stevens-Johnson syndrome (SJS) is a rare, potentially life-threatening, mucocutaneous reaction leading to extensive necrosis and detachment of the epidermis. SJS commonly follows a viral prodrome or drug hypersensitivity reaction with an incidence of 1 to 2 cases per million per year. The long-term sequelae include mucosal, pulmonary, cutaneous, vulvovaginal and rarely esophageal complications. We present a rare case involving a pregnant patient with multiple esophageal strictures due to SJS requiring repeat balloon dilations. CASE DESCRIPTION/METHODS: A 32 year old pregnant female with a history of drug induced SJS, complicated by multiple esophageal strictures and vaginal stenosis, presented with symptoms of recurrent, persistent solid food dysphagia and weight loss. Barium esophagram showed a mid-esophageal stricture measuring 5 mm in diameter and a distal stricture measuring 2 mm in diameter just proximal to the gastroesophageal junction. Due to the severity of symptoms, pregnancy, and the etiology of the stricture, the patient was started on a graded stepwise dilating approach by esophagogastroduodenoscopy (EGD). Repeat dilations were done by a “rule of 3” approach using a Savary dilator every two to three weeks. A maximal diameter of 10 to 11 mm was achieved and symptom relief improved throughout the patient’s pregnancy. The patient had no procedural complications and delivered a healthy baby at 39 weeks by cesarean section. DISCUSSION: Over 12,000 EGDs are performed annually on pregnant women and limited follow up data showed it as relatively safe for both the mother and fetus. SJS with esophageal involvement is exceptionally rare in adults with only a few reported cases and even fewer cases during pregnancy. Esophageal strictures secondary to SJS share many similarities to strictures caused by corrosive ingestion in both presentation and management. Corrosive ingestion strictures are treated by repeated dilation and one study showed a long term satisfaction of greater than 90%. In our case this was weighed against the higher incidence of iatrogenic injury to both the mother and fetus. Further research will need to be done to determine the long term complications in pregnant patients after repeat dilations.

3115 Bronchoscope in the Esophagus?! A Novel Technique for Esophageal Strictures Management

INTRODUCTION: Benign esophageal strictures can result from long-standing GERD, ablative or radiation therapy, corrosive substance ingestion etc. Management of strictures could be very challenging. We describe a case of esophageal strictures that was managed with an innovative approach. CASE DESCRIPTION/METHODS: A 36-year-old Indian female with a history of esophageal strictures secondary to caustic ingestion 9 years ago presented with complaints of dysphagia. Patient underwent multiple EGD with dilatations in the early years of her stricture formation. Subsequently she was taught to perform self dilations in India, every 2 weeks to relieve dysphagia. An esophagram revealed a narrow caliber mid and distal esophagus with 3 prominent stricture points. During endoscopy an 8.8 mm gastroscope could not traverse the most proximal stricture hence a bronchoscope was used to evaluate the number and size of strictures for optimal use of pneumatic balloon catheter for dilation. The bronchoscope evaluation revealed 3 esophageal strictures at 25 cm, 30 cm and 35 cm from incisors. Serial dilations were performed with a balloon dilator and triamcinolone was then injected at the stricture site post dilation. Following this intervention she was able to defer dilatation for 6 weeks. Using a Bronchoscope a second session of dilatation and triamcinolone injection was repeated 6 weeks later. Therapy was required for one of the three strictures with the others having healed well. Patient has not been performing self dilations since her first EGD and continues to be asymptomatic. DISCUSSION: Caustic ingestion and its gastrointestinal sequelae such as stricture formation have been an important public health concern for decades. Damage and complications depend on several aspects: substance concentration and pH, length of time of tissue contact and amount ingested. The primary treatment of a caustic esophageal stricture is endoscopic dilatation, however sometimes management could be challenging. Using a bronchoscope (thin caliber scope), the high grade strictures in our patient were traversed and evaluated optimally prior to execution of the treatment modality. In our extensive literature review, a bronchoscope has never been used before for managing high-grade strictures, which makes our case unique. We believe that this new technique of utilizing a bronchoscope for evaluation of high-grade strictures can provide more targeted therapeutic approach and superior management to the patient.

2670 A Highly Lethal Case of Gastric Pneumatosis

INTRODUCTION: While gas can accumulate in the intestinal wall at multiple sites, the stomach is the rarest site because of its acidity and very efficient mucosal barrier. In has been proposed in one retrospective study that 46% of their cases involved the colon, 27% the small bowel, 14% in whom the whole gastrointestinal tract was infected including the portal venous system, 7% the small bowel with the colon, and only 5% the stomach as in our case. CASE DESCRIPTION/METHODS: An 83 year old male with history of coronary artery disease, diabetes mellitus, bullous pemphigoid and smoking history presented for shortness of breath over one week. Patient was tachypnic and using accessory muscles on exam. During his hospital course, he had abdominal pain. CT Scan showed fluid filled distal esophagus, distended stomach, air-fluid levels and peripheral lucencies concerning for intramural gas. Nasogastric tube put out a large amount of red emesis after which he expired. DISCUSSION: There are two distinct pathological processes involved in air within the lumen of the stomach which is termed gastrointestinal pneumatosis. The first type is called gastric emphysema which often has a benign course and constitutes 9% of all gastrointestinal pneumatosis cases. Gastric emphysema is classified as traumatic, pulmonary or obstructive types. There have only been 5 recorded cases of gastric emphysema with a pulmonary etiology and four of those cases were secondary to bullous emphysema. The second type is emphysematous gastritis which involves gas forming organisms including Pseudomonas aeruginosa, Candida albicans, and Staphylococcus aureus. The risk factors for this dangerous type of gastrointestinal pneumatosis include a history of abdominal surgery or manipulation, bowel infarction/ischemia, immunosuppression which include disease processes including diabetes, alcohol abuse or corrosive material ingestion. There is a mortality of 16% in those receiving surgical treatment versus 6% who received only conservative treatment. In stable patients, improvement in clinical condition or emphysema resolution within 3 days occurs with nasogastric catheter decompression as attempted in our case. This becomes important in identifying between gastric emphysema, a relatively benign course, or emphysematous gastritis, which has a poor prognosis. As time becomes an increasingly prognostic factor for these individuals, differentiation in treatments based on type could lead to faster implementation which could ultimately help to prevent demise.

Colon interposition in the treatment of corrosive esophageal strictures: 100 patients in seven years

Background: The purpose of this study is to represent the change in our concept of principles and techniques of esophagocoloplasty (midcolon esophagocoloplasty) with repetitive performance of the operation and approach of early surgical intervention (within 4-6 month of corrosive ingestion) in place of repetitive trials of dilatations and medical management, provides early better quality of life with lesser period of suffering and saving expenditure of treatment.Methods: This retrospective study comprises of consecutive 100 patients operated for colon interposition for corrosive stricture of esophagus done at two university linked government teaching hospitals during March 2011 to March 2018. Out of 100 patients, 77 female and 23 male (3:1), mean age 30.6 years (range from 21 to 47 years), mean hospital stay was 14.5 days (range 10 to 25 days) and mean operative duration was 4.5 hours (range 2.5 to 7 hours).Results: The 30 day in hospital mortality rate was 9%. There were 14 instances of leak at the esophagocolic anastomosis (14%), graft necrosis occurred in 01 patient, 08 patients (8%) developed stenosis at the esophagocolic anastomosis. More than 90% patients (n=77) had ‘Good’ result, 06 patients had ‘Fair’ and 02 had ‘Poor’ result.Conclusions: Midcolon graft is a solution for confusion in judgment of adequate length of graft and offer uniformity in procedure with effectively lesser operative time. Early (4-6 months after ingestion) operative intervention is advantageous to patients suffering from crippling dysphagia with repeated admission and expenditure from multiple endoscopic dilatations.

Peritonitis secondary to non-traumatic small and large bowel perforation

Background: The objective of the study was to determine the outcome of secondary peritonitis in non-traumatic small and large bowel perforation in a secondary care hospital in the region of Ha’il, Kingdom of Saudi Arabia (KSA).Methods: This prospective study was conducted in a surgical unit of King Khalid Hospital, Ha’il Kingdom of Saudi Arabia, from 01 October 2013 to 30th June 2014. 30 patients were admitted through emergency room (ER). Every patient was enquired a detailed history about abdominal distension, abdominal pain, fever, constipation, vomiting, and gut motility. Clinical examination of the patient was done. Baseline investigations along with chest radiograph posterio-anterior (PA) view, abdominal radiograph with erect and supine views and ultrasound whole abdomen were included. All patients landed in the ER with peritonitis due to gastrointestinal perforation, regardless of their sex and age, were included. Peritonitis of primary cause or due to trauma, corrosive ingestion and anastomosis leak were excluded. Follow up of all the patients was done. Data was analyzed through SPSS software 16.Results: Out of 30 patients, 23 (76.66%) were male and 7 (23.33%) were female. Mean age 36.28±2.3 years. 80% presented with abdominal pain. Pneumoperitoneum on chest X-Ray was found in 21 (70%) patients. Duodenal perforation was the most common reason of peritonitis in 14 patients (46.66%). Surgical site wound infection is the commonest complication in 16 patients (53.33%).Conclusions: In conclusion, the outcome of secondary peritonitis in our Eastern population is perforation of the upper gastrointestinal tract and small bowel as the documented common cause, and wound infection as the commonest complication.