Cases reported "Burns, Chemical"

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1/76. Local corticosteroid treatment of caustic injuries of the esophagus. A preliminary report.

    So far, no therapy has been shown to reduce the incidence of strictures in the esophagus after ingestion of caustic agents. Two patients with pronounced caustic ingestion injuries were treated locally with solutions of corticosteroids normally used for inhalation therapy in lung diseases. Serious strictures did not appear, and their swallowing returned to normal. Further studies are needed.
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2/76. Pancreaticocolonic fistula after extensive corrosive injury from esophagus to jejunum.

    We report a case of extensive corrosive injury to the jejunum after ingestion of about 200 ml of hydrochloric acid as an attempted suicide. Subtotal esophagectomy, total gastroduodenectomy, segmental resection of the jejunum and partial pancreatectomy were performed in the first two operations. Forty-five days after surgery, the patient was well and discharged. Six months later, the patient underwent esophageal reconstruction surgery. During surgery, a pancreaticocolonic fistula between the head of the pancreas and the transverse colon was found. The esophageal reconstruction using the transverse colon was performed via the retrosternal route.
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3/76. colon interposition in a patient with total postcricoid stenosis after caustic ingestion and preservation of full laryngeal function.

    Caustic burns of the upper aerodigestive tract continue to be a significant clinical problem. However, the available literature uncommonly mentions changes affecting the larynx. We could find only one publication in which four cases of high hypopharyngeal stenosis were described in detail and where the functional outcome of the laryngeal function was stated as partially saved. We describe here a case of total retrocricoid stenosis in a 28-year-old woman that was caused by lye ingestion. A life-saving gastroesophagectomy was performed by the Department of general surgery. Reconstruction of the esophagus was carried out with mobilized right colon, which was meticulously sutured circumferentially behind the arytenoids and on the prevertebral fascia. The anatomy of the larynx and its nerve supply were scrupulously maintained intact. We believe that our patient's rehabilitation was due mainly to an intensive 18-month program of care, following which all laryngeal functions recovered with normal voice and swallowing patterns.
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4/76. Use of esophagectomy to treat recurrent hyperplastic tissue obstruction caused by multiple metallic stent insertion for corrosive stricture.

    We report a case of a 75-year-old woman who received repeated metallic stent insertion for corrosive esophageal injury. She underwent esophagectomy and gastric tube reconstruction about 3 years after injury because both stents were occluded in turn by overgrowth of granulation tissue. The gross and microscopic changes of the esophagus secondary to prolonged stent insertion are described. In the literature, no reports of similar cases have been recorded. Our limited experience revealed that using metallic stents to treat benign esophageal stricture should be handled very cautiously because of the complications which can commonly occur and are difficult to manage. Repeated stent insertion, although effective for temporarily relieving dysphagia, is ineffective in the long run and can create complications. We suggest that the feasibility of esophagectomy should be evaluated after the improvement of the general condition of the patient.
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ranking = 0.2
keywords = esophagus
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5/76. Microsurgical reconstruction for caustic injuries of the oral cavity and esophagus.

    Ingestion of caustic material often produces profound and irreversible pathologic changes that require reconstructive surgery of the organs damaged. This report describes the authors' successful experience with microsurgical techniques that allowed adequate reconstruction in three patients with cicatricial contracture of the oral cavity and esophagus following ingestion of caustic substances. All patients had attempted suicide by ingesting liquid alkali. patients #1 and #2 complained of limited mouth opening and impaired tongue movement due to oral scar contracture. contracture release in the first patient resulted in a defect from the anterior border of the mandible to the retromolar region. The defect was resurfaced with a 6 x 12 cm free forearm flap. Release of the scar contracture in the second patient resulted in a long, narrow, tortuous defect that was difficult to cover, even with a forearm flap, and a jejunal segment was microsurgically transferred as a patch graft to reconstruct the defect. Patient #3 had dysphagia due to stricture of the cervical portion of the esophagus. The defect after resection of the cervical portion was reconstructed by free jejunal interposition. Appropriately selected free-flap transfer in each case provided a satisfactory restoration of function of the oropharyngeal and digestive passages.
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ranking = 1.2
keywords = esophagus
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6/76. colon-patch oesophagoplasty.

    colon-patch oesophagoplasty has been tried experimentally and used clinically to treat benign strictures of the oesophagus in children. However, reports are few. We advocate this operation and report on two cases where this technique was employed for caustic stricture using a vascularized colon patch avoiding the need for oesophageal substitution. This procedure has its immediate and late complications but after a long follow-up we are satisfied with our results. Patching is a useful alternative to substitution for limited benign strictures of oesophagus in children.
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ranking = 0.4
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7/76. Corrosive injuries of the esophagus in newborns.

    To evaluate the morbidity and mortality of corrosive esophageal injuries (CEI) in the neonatal period, the records of 184 children hospitalized following caustic ingestion over a 10-year period from January 1987 to November 1997 were reviewed. Eight (4.3%) were newborns (5 boys and 3 girls). The mean age of the newborns was 12 days (range 1-28). The ingested caustic materials were benzalkonium chloride in six patients and trichloroacetic acid in two. Oropharyngeal examination and esophagoscopy were performed for diagnosis. hyperemia and fibrin plaques were present in the oropharynx in all patients. The management consisted of endotracheal intubation, antibiotics, corticosteroids, and total parenteral nutrition. pneumonia and sepsis developed in three patients and one died of sepsis. Stenosis developed in two patients, who were treated three times with antegrade dilatations. The morbidity was 62.5% (five patients) and the mortality was 12.5% (one) in newborns with CEI. These results indicate that ingestion of a caustic substance results in high morbidity and mortality in newborns. parents and nurses should be warned about this risk.
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ranking = 0.8
keywords = esophagus
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8/76. Redoing reconstruction of the esophagus using remnants of the ileo-left colon aided by microvascular anastomosis.

    Theoretically, the jejunum, fasciocutaneous or myocutaneous flap is recommended as an esophageal substitute in redoing reconstruction of the esophagus after a second incidence of corrosive injury. However, other esophageal substitutes should also be considered. We present a case of a 42-year-old woman who underwent esophageal reconstruction using an ileocolon graft for corrosive esophageal stricture ten years before. The patient ingested caustic drain cleaner again and underwent resection of the ileocolon graft secondary to corrosive necrosis. Two and a half months after the second incidence of corrosive injury, reconstruction of the esophagus was again performed using a graft of remnant ileo-left colon aided by microvascular anastomosis. The patient was able to swallow a regular diet after the procedure. Remnant ileo-left colon is a good alternative esophageal substitute in cases of repeated corrosive injury.
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ranking = 1.2
keywords = esophagus
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9/76. Alkaline esophagitis evaluated by endoscopic ultrasound.

    Case Report: Two patients with corrosive esophagitis caused by alkaline household agents were examined with endoscopic ultrasound using a 20-MHz probe. In the first case, endoscopic ultrasound revealed circumferentially thickened mucosa and muscularis propria, and lack of differentiation between the mucosa and submucosa. However, esophageal stricture did not develop during 3 months of follow-up, suggesting that the deep lesion may have involved a narrow section of esophagus only. In the second case, a markedly thickened mucosa was seen, resulting in no sequelae. Endoscopic ultrasound offers a more accurate evaluation of the depth of the lesions in alkaline esophagitis compared to standard endoscopy or computed tomography. longitudinal studies are needed to identify lesions at greatest risk for progression to stricture.
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ranking = 0.2
keywords = esophagus
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10/76. Cololaryngostomy procedure in caustic esophageal burns.

    The study presented herein was undertaken to report an original case of cololaryngostomy operation in caustic esophageal burns. Cololaryngostomy application to a chronic caustic esophageal burn case is reported with a detailed literature review of the topic. For the first time in the world, the larynx was used for the integrity of the gastrointestinal system by applying a cololaryngostomy procedure as it was found to be the only intact and reliable tissue in the operation. The patient started to gain weight in a 3-month period. Oral nutrition and speech were also achieved. Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx and esophagus is an important reconstructive problem. In reconstruction, the aim should be the supplementation of both oral nutrition and speech.
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ranking = 0.2
keywords = esophagus
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