Perioperative Evaluation of Patient Outcomes after Severe Acid Corrosive Injury

Abstract

We reviewed 64 patients with perforation or full-thickness injury of the alimentary tract after acid ingestion. Based on our classification of laparotomy findings, there were class I (n=15); class II (n=13); class III (n=16); and class IV (n=20). Study parameters were preoperative laboratory data, gastric perforation, associated visceral injury, and extension of the injury. End points of the study were the patients’ mortality and length of hospital stay. All these patients underwent esophagogastrectomy with (n=16) or without (n=24) concomitant resection, esophagogastroduodenojejunectomy with (n=4) or without (n=13) concomitant resection, and laparotomy only (n=7). Concomitant resections were performed on the spleen (n=10), colon (n=2), pancreas (n=1), gall bladder (n=1), skipped areas of jejunum (n=4), and the first portion of the duodenum (n=4). The study demonstrates five preoperative risk factors, female gender, shock status, shock index, pH value, and base deficit, and four intraoperative risk factors, gastric perforation, associated visceral injury, injury beyond the pylorus, and continuous involvement of the jejunum over a length of 50 cm. The overall mortality rate was 45.3%, which increased significantly with advancing class of corrosive injury.