Is there a Difference Between the Management of Grade 2b and 3 Corrosive Gastric Injuries?
CHITTINAD HA V ANOND, M.D.*
Affiliation : * Department of Surgery, Faculty of Medicine, Thammasart University, Bangkok 12120, Thailand.
Objective : To evaluate the differences between treatment of patients with grade 2b or grade 3 gastric injuries.
Setting : A University Hospital.
Design : Retrospective review.
Patients : Thirty patients who ingested caustic agents over a 5 year period were examined by endoscope within 48 hours of injury. Result : Twenty one patients ingested strong acid or alkali. Among these patients, five had grade 2b, and two had grade 3 injuries. In both cases of grade 3 injuries, extensive surgical approach was initially performed, then delayed jejunal and colonic interpositions were done. On the other hand, one 2b patient had exploratory laparotomy, while others were treated conservatively. All 2b patients had satisfactory conditions during the initial follow-ups. Three patients were healthy during the 11, 16, and 44 months follow-up, one developed chronic gastritis at 5 months and one patient failed to follow-up.
Conclusion : Early and aggressive extensive removal of necrotic tissue is necessary and can certainly increase the survival. There is on going controversy in the management of injuries less than grade 3. Grade 2b gastric injury patients can be managed conservatively.
Keywords : Corrosive Ingestion, Corrosive Injury, Esophageal Stricture, Esophago-Gastrectomy, Esophageal Replacement
