Catastrophic Caustic Ingestion: A Case Report

Abstract

Introduction: The majority of oral ingestion of caustic material by adults is intentional, and the aftermath varies widely with potentially fatal results. Injuries range from superficial burns of facial and oropharyngeal structures to extensive necrosis of the gastrointestinal tract. Management focuses on the identification of the ingested substance and prompt treatment and supportive care of the multiple complications stemming from the ingestion. Complications following caustic ingestion include both immediate and long term.

Case presentation: A fifty-seven-year-old man presented following intentional ingestion of drain cleaner. The patient was intubated and underwent emergent esophagogastroduodenoscopy [EGD], which revealed extensive damage to his oesophagus and stomach. He survived his initial injury but had a prolonged hospital course and ultimately died after developing tracheoesophageal and bronchooesophageal fistulas which were too extensive for surgical repair.

Conclusion: The sequelae of caustic ingestion can be minor or severe, both immediate and delayed. Despite appropriate prompt management and supportive care, patients may die as a result of the initial injury or subsequent complications.

Keywords: caustic ingestion; caustic injuries; suicide; toxic ingestion.

Fig. 1

EGD image of diffusely inflamed oesophageal mucosa

Fig. 2

EGD image of inflamed oesophageal mucosa with diffuse ulceration and sloughing

Fig. 3

Extensive burns and eschar to the patient's lower lip, chin, and left cheek

Fig. 4

Bronchoscopy image of oedematous tissue of the epiglottis with diffuse tissue damage

Fig. 5

Bronchoscopy image of oedematous vocal cords with diffuse tissue damage