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Citation |
Heyman S, Delalieux S, Ruppert M, Balliu L, Hubens H, Vaneerdeweg W. Tijdschrift voor Geneeskunde 2008; 64(11): 590-594. |
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Copyright |
(Copyright © 2008) |
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DOI |
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PMID |
unavailable |
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Abstract |
The presented patient tried to commit suicide with Destop® (sodiumhydroxide). She presented with a low coma-scale, complaints of throat-ache, hematemesis and thoracic discomfort. Her personal medical story included a history of depression. Further clinical examination revealed edema and erosions of the mouth mucosa. Esophago-gastro-duodenoscopy disclosed a necrotic mucosa from the esophagus till the duodenum (D2) with a caustic esophagitis grade IIIB. The staging and poor prognosis called for a surgical intervention. An esophagectomy and total gastrectomy were performed. In a second time an isoperistaltic coloninterposition with jejunocolostomy and cervical anastomosis was carried out. Initially no complications did occur, but after a few days the patient developed a pneumonia and a colo-colic leak. Ultimately healing was obtained. During childhood alkali are usually accidentally ingested. When presenting in adults it is usually of suicidal origin. Alkali mostly attack the esophagus while acids affect the stomach. Due to the great risk for lesions of the respiratory tract alkali or acids should never be inhaled. Admission of these patients to an intensive care unit is advocated. Surgical interventions include a stomach pull-up, a jejunal interposition or a coloninterposition. When surgery is performed a close awareness and anticipation of complications (e.g. leakage or pneumonia) are required. A colon interposition remains the first choice. Using the stomach includes a greater risk of developing a leak, while the vasculature of the jejunum is not ideally suited. Language: nl |
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Keywords |
human; suicide; female; case report; article; hospital admission; clinical feature; intensive care; anamnesis; clinical examination; exposure; sodium hydroxide; pneumonia; acid; esophagus resection; gastrectomy; vascularization; anastomosis; respiratory system; esophagogastroduodenoscopy; mucosal necrosis |