Esophagogastric Complications After Caustic Ingestion: A Case Report

Abstract

Ingestion of corrosive agents is a well-known factor in extensive GI tract injury. Either acids or alkalis can lead to significant immediate and long-term complications throughout the GI system. The ingestion of these substances in children is often accidental, however, it is typical that in adults is due to suicidal attempts. A 25-year-old male with a history of suicidal attempt one month ago comes to the GI clinic due to unintentional weight loss of 19%, dysphagia of solids, emesis, and regurgitation. Evaluation with an upper gastrointestinal endoscopy was done which showed severe esophageal stenosis (90%), esophagitis Zargar 3a, and total pyloric stenosis. A dilation procedure was attempted, but complicated by severe bleeding; thus, the patient was hospitalized for a new attempt. During the second endoscopy, an esophageal dilation was successfully performed, but the pyloric dilation could not be completed. For that reason, a hepato-pancreato-biliary surgeon was consulted and a jejunostomy was performed for enteral nutrition. Caustic agent ingestion can cause different types of injuries including laryngospasms, perforations, necrosis, and mediastinitis in the short term. On the other hand, esophageal stenosis (ES), gastric outlet obstruction (GOO), and esophageal cancer can appear in the long term. In this case, we highlighted the importance of prompt recognition, identification, and grading of the lesions to determine a better outcome and prognosis for the patient.

Keywords: caustic ingestion; caustic injury; esophageal cancer; esophageal stenosis; gastric outlet obstruction.

Figure 1. Esophageal stenosis with 90% of lumen obstruction (black arrow); esophagitis Zargar 3a (blue arrow)

Figure 2. Total pyloric stenosis (arrow)

Figure 3. Failed attempt at pyloric dilation (arrow)