Successful treatment of gastric necrosis after ingestion of hydrochloric acid: a two-stage minimally invasive surgical procedure

BMJ Case Rep. 2019 Oct 25;12(10):e231879. doi: 10.1136/bcr-2019-231879.

Abstract

Caustic ingestion may cause devastating injuries of the upper gastrointestinal tract and the respiratory system. We report here the successful treatment of a 37-year-old patient who ingested hydrochloric acid (100 mL; 24%) in suicidal intention. An oesophagogastroduodenoscopy revealed extensive necrosis of the gastric mucosa. A diagnostic laparoscopy was performed and confirmed the suspected transmural necrosis which resulted in a discontinuous laparoscopic gastrectomy. During the next days, the oesophageal stump was monitored through frequent oesophagoscopies and showed a good recovery. Thus, it was possible to restore continuity as early as by the sixth postoperative day performing a roux-en-y oesophagojejunostomy using the da Vinci Xi surgical robot. The patient underwent all procedures without any surgical complications and was discharged almost 1 month after initial presentation in good general condition.

Keywords: emergency medicine; endoscopy; gastrointestinal surgery; stomach and duodenum; suicide (psychiatry).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anastomosis, Roux-en-Y
  • Diagnosis, Differential
  • Gastrectomy
  • Gastric Mucosa / injuries*
  • Gastric Mucosa / surgery*
  • Humans
  • Hydrochloric Acid / poisoning*
  • Male
  • Minimally Invasive Surgical Procedures
  • Necrosis / chemically induced
  • Necrosis / surgery
  • Robotic Surgical Procedures
  • Suicide, Attempted

Substances

  • Hydrochloric Acid