Caustic injury of the upper gastrointestinal tract in adults: a clinical and endoscopic study

During the past 8 1/2 years, we have treated 34 adult patients admitted for ingestion of caustic materials. In 19 patients the injury was accidental, and in 15 patients ingestion was a suicide attempt. Ingested agents included hydrochloric acid in four patients, sulfuric acid in one patient, a strong alkali such as sodium hydroxide or Drano in 15 patients, liquid bleach in eight patients, detergents in four patients, and ammonia in two patients. Each patient underwent early fiberoptic endoscopic evaluation. The extent and severity of the injury varied according to the ingested agent. Seven patients who had second- or third-degree injury had surgery. One patient who ingested sulfuric acid required hemigastrectomy for pyloric stenosis. Two patients with Drano ingestion had necrosis of the stomach and required total gastrectomy. Five patients with strong alkali ingestion had esophageal strictures, and colonic interposition was performed on four of these patients. No patient who had ingested bleach, ammonia, or detergent required surgery. Panendoscopy after caustic ingestion can be performed safely and provides an accurate guide for therapy. The ingestion of strong acid or alkali may produce profound pathologic changes, which may require surgery for perforation or stricture. Bleach, detergent, and ammonia usually cause mild injuries that will respond with medical treatment.