[Surgery for disease of the esophagus. 8. Corrosive esophagitis]

After the ingestion of caustic substances, not only the esophagus but also the gastrointestinal tract is injured. Severe caustic upper gastrointestinal tract injuries are associated with high mortality and morbidity rates when mediastinitis, chemical peritonitis, or perforation of the gastrointestinal tract occurs. Perforation may occur in the late phase, especially with the ingestion of alkaline solution, because the inflammation invades more deeply with the continuous release of OH-after coming into contact with protein. Therefore care must be taken in the estimation of the extent of inflammation after the ingestion of caustic alkaline solution. There are on established indications for surgery in acute-phase corrosive esophagitis. At present, we determine the indications for surgery based on blood gas examination, endoscopy, and computed tomography (CT). Blood gas examination is used to diagnose the systemic status. Endoscopy reveals corrosive changes with mucosal injury, while CT reveals the presence of mediastinitis, chemical peritonitis, and gastrointestinal tract perforation in the acute phase. Patients in the acute phase first undergo limited resection of the injured organs without reconstruction, with secondary esophageal reconstruction performed subsequently. This paper reports on our successful experience in the early surgical treatment of patients who had severe tissue injury after the ingestion of caustic substances. Patient prognosis was good using our surgical technique.