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Assessment and management after corrosive ingestion: when is specialist centre referral needed? A 10-year UK experience

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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.

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Abbreviations

ITU:

Intensive therapy unit

CT:

Computed tomography

OG:

Oesophago-gastric

ENT:

Ear, nose and throat

A&E:

Accident and emergency

NBM:

Nil by mouth

GDA:

Gastro-duodenal artery

WCC:

White Cell Count

CRP:

C-reactive protein

NGT:

Naso-gastric tube

RIP:

Rest in peace

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Authors and Affiliations

  1. Upper Gastro-Intestinal Unit, Department of Surgery, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK

    Francesco Di Maggio, Vittoria Vergani, Chuan Zhang, James Gossage, Abrie Botha & Cara Baker

  2. General and Emergency Surgery, Guys and St Thomas NHS Foundation Trust, London, UK

    Vittoria Vergani & Ivan Tomasi

Authors
  1. Francesco Di Maggio
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  2. Vittoria Vergani
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  3. Ivan Tomasi
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  4. Chuan Zhang
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  5. James Gossage
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  6. Abrie Botha
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  7. Cara Baker
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Contributions

FDM and IT conceived the project; FDM, VV and CZ collected the data; FDM analysed the data; FDM and VV wrote the manuscript; AB and JG managed the most complicated patients; CB supervised the project. All authors provided critical feedback and helped shape the research, analysis and manuscript.

Corresponding author

Correspondence to Francesco Di Maggio.

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Disclosures

Francesco Di Maggio, Vittoria Vergani, Ivan Tomasi, Chuan Zhang, James Gossage, Abrie Botha and Cara Baker have no conflicts of interest or financial ties to disclose. The protocol for this research project was approved by Guys and St Thomas NHS Foundation Trust Ethics committee and conforms to the provisions of the Declaration of Helsinki.

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Di Maggio, F., Vergani, V., Tomasi, I. et al. Assessment and management after corrosive ingestion: when is specialist centre referral needed? A 10-year UK experience. Surg Endosc 36, 5753–5765 (2022). https://doi.org/10.1007/s00464-022-09174-1

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  • DOI: https://doi.org/10.1007/s00464-022-09174-1

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