Combined duodenal and colonic necrosis. An unusual sequela of caustic ingestion

Two unusual cases of liquid caustic ingestion that resulted in gangrene of the duodenum and adjacent colon, and burns of the esophagus, stomach, and pancreas are presented. The routine evaluation of the oropharynx, esophagus, and stomach after liquid caustic ingestion can seriously underestimate the extent of injury to distal portions of the gastrointestinal (GI) tract, such as the colon and pancreas, that are not usually included in the initial evaluation of ingestion injuries. In stable patients managed nonoperatively, the entire upper GI tract, including the duodenum, must be visualized either by endoscopy or, less preferably, by barium series. Double-contrast computed tomography should be performed when significant duodenal injuries are present in order to inspect the colon, pancreas, and small bowel. With this approach, life-threatening, multi-organ, subdiaphragmatic ingestion injuries can be identified and treated early.