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| 篇名 |
Flexible Esophagoscopy in the Management of Acute Corrosive Esophageal Injury in Adults |
| 作者 |
Va-Kei Kok, Tai-Chow Chiang |
| 卷期/出版年月 |
39卷3期 (2006/6) |
| 頁次 |
133-138 |
| 摘要 |
Objective: Early use of flexible esophagoscopy in the management of acute phase of
corrosive esophageal injury remains controversial in emergency room (ER). The
purpose of this retrospective study was to evaluate the essential role of flexible
esophagoscopy in both the diagnosis and primary surgical treatment of the acute corrosive
esophageal injury in ER.
Methods: Four-hundred and forty-nine patients with corrosive injury of the upper
gastrointestinal (UGI) tract due to ingestion of a corrosive substance between 1990
and 2000 were included in this retrospectively analysis. Acute lesions were classified
into 3 grades according to the findings of esophagoscopic assessment. The criteria for
selecting patients for emergency exploratory laparotomy were esophagoscopic
findings showing third degree chemical burn of severe corrosive injury or grade 2
chemical burn in the proximal esophagus with suspicion of distal perforation, continuous
bleeding from the gastrointestinal tract, or lack of cooperation for esophagoscopic
assessment with signs of peritonitis.
Results: Following the selection criteria for operation indications, 57 patients (age
range 10 to 85 years; mean 44.5 years) with severe injury that underwent esophagoscopic
clinical assessment was included in this study. The majority were adult who
had attempted suicide, and hydrochloric acid (HCl) was the most common ingested
agent. The male/female ratio was 1:2.05. Fifty patients, including grade 2 esophageal
injury in 22 patients and grade 3 esophageal injury in 28 patients revealed by
esophagoscopy, required surgery due to deep burn and six of them died. Seven
patients who were considered to have the surgical indication of grade 3 chemical burn
found on the esophagus and stomach was treated conservatively due to refusal of
operation, but all of them died. The cause of death was sepsis and multiple organ
failure in 12 patients. One patient died as a result of shock secondary to massive
gastric bleeding. Operative complications occurred in seven patients, including cervical
wound infection in two patients, aspiration pneumonia due to pharyngeal dysfunction
in three patients, cerebral infarction in one and acute mediastinitis due to residual esophagitis in one.
Conclusions: Our results suggest that early flexible esophagoscopy in the corrosive
injury of UGI tract in adults can help delineate the extent of damage caused by corrosive
compounds and play an important role as an indicator for early surgery. Early
assessment with esophagoscopy by surgeons is essential to the appropriate management
with the corrosive injury of UGI tract in ER. |
| 關鍵詞 |
flexible esophagoscopy, assessment, early operation, corrosive injury |
| 分類 |
Original Article |
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