Management of Severe Caustic Lesions of the Upper Digestive Tract at the Brazzaville University Hospital

Abstract

Caustic ingestions represent a medical-surgical emergency that requires multidisciplinary collaboration (gastroenterologists, visceral surgeons, intensive care specialists, toxicologists, and psychiatrists). Goal: To improve the management of severe caustic lesions of the upper digestive tract. Patients and Methods : This was a retrospective, descriptive study covering a five-year period from January 1, 2013 to December 31, 2018. It took place at the Brazzaville University Hospital Center in the Gastroenterology and Internal Medicine (GEMI) and Digestive Surgery departments. We included all patients 18 years of age and older admitted for ingestion of caustics with severe lesions or with upper gastrointestinal endoscopy that showed caustic lesions stages IIb to IV according to the Di-Constanzo classification. The study variables were epidemiological, clinical, morphological, evolutionary and therapeutic. The study data were entered and analyzed using Microsoft Excel version 2016, CS Pro version 7.2, and SPSS software. Quantitative variables were expressed as ± standard deviation. Qualitative variables were expressed as percentages. The range of values considered normal was ±2 standard deviations. Results : Severe caustic lesions were found in 60 cases, i.e. , a frequency of 31.6%. There were 16 women and 44 men, i.e. , a sex ratio of 2.8 with an average age of 35.58 years. Sulphuric acid was the most commonly used caustic in 29 cases, i.e. , a frequency of 48.3%. The amount of the product ingested was approximately ≥ 150 ml in 32 cases or 53.33%. The time to admission was less than 24 hours in 34 cases, i.e. , 56.7%, and the time to perform upper gastrointestinal endoscopy was more than 24 hours in 19 (31.7%) of the cases. The damage was diffuse, oesophagus and stomach simultaneously. Peripheral parenteral feeding was practiced in all cases. Stenosis was the major complication in 29 (48%) patients. No emergency surgery was performed, and complication surgery was performed in 3 (5%) patients. Conclusion: The management of severe caustic lesions is inadequate. The time taken to admit and take the exams is late. Emergency surgery, which is the ideal treatment, is not performed in our context.