背景:在儿童中几乎是偶然发生的,在成人中大多是故意的。摄入腐蚀性物质会对胃肠道造成不同程度的损害。根据损伤的严重程度,手术可能是治疗计划的一部分。
方法:一名32岁的男子在吞下排水管清洁器后转诊至我院。由于腹膜炎的证据和内窥镜检查结果,他接受了紧急手术。在手术过程中,坏死部位,包括食道,胃,十二指肠,胰头,空肠的初始部分,被切除了。然后,六个月后,进行结肠间置术以重建胃肠道。
结论:像创伤患者一样,治疗有腐蚀性损伤的患者从对气道的初步调查开始,呼吸,和流通状态。在最初的48小时内,早期食管镜检查用于评估损伤量。透壁性坏死或穿孔的证据是手术的最重要指征,和外科手术是每个病人特有的。食管胃切除术是严重胃肠道损伤的最常见的手术,但是在较少的情况下,可能需要切除更多的腹部器官。
结论:本病例报告强调迫切需要进一步研究和制定处理胃肠道广泛坏死的苛性损伤的循证指南。我们对这种罕见病例的经验强调了此类指南在改善患者预后方面的重要性。
BACKGROUND: Caustic ingestion almost occurs accidentally in children and mostly intentionally in adults. The ingestion of
caustic substances can cause various degrees of damage to the gastrointestinal tract. Depending on the severity of the injury, surgery may be a part of the treatment plan.
METHODS: A 32-year-old man was referred to our hospital after swallowing drain cleaner. Due to evidence of peritonitis and endoscopy results, he underwent emergency surgery. During the surgery, necrotic parts, including the esophagus, stomach, duodenum, head of the pancreas, and initial part of the jejunum, were resected. Then, after six months, colon interposition surgery was done to reconstruct the gastrointestinal tract.
CONCLUSIONS: Like trauma patients, managing patients with
caustic injuries begins with an initial survey of the airway, breathing, and circulation status. In the first 48 h, early esophagoscopy is indicated to evaluate the amount of injury. Evidence of transmural necrosis or perforation is the most important indication for surgery, and surgical procedures are specific to each patient. Esophagogastrectomy is the most common surgery in cases of severe gastrointestinal injuries, but removing more abdominal organs may be needed in fewer cases.
CONCLUSIONS: This case report underscores the urgent need for further research and the development of evidence-based guidelines in managing
caustic injury with extensive necrosis in the gastrointestinal tract. Our experience with this rare case highlights the importance of such guidelines in improving patient outcomes.