Isolated Full Thickness Jejunal Necrosis Following Sulphuric Acid Cocktail Ingestion – A Clinical Case Report—Isolated Corrosive Jejunal Necrosis

S. S. Pankaja, George J. Valooran, Sri Aurobindo Prasad Das, L. Suvasini, R. Aravind, Vikram Kate, Pankaj Kundra

.

DOI: 10.4236/ss.2011.26072                

Abstract

Isolated involvement of the lower gastrointestinal tract with relative sparing of the oesophagus and the stomach is extremely rare following corrosive agent ingestion. We report a case of isolated full thickness jejunal necrosis following sulphuric acid cocktail ingestion. A 42 year old man presented with history of consuming 200ml of sulphuric acid mixed with alcohol, with suicidal intent. On exploration there were multiple, full thickness necrotic areas in the proximal jejunum with minimal congestion of the oesophagus, stomach and duodenum. Inversion of the jejunal necrotic areas with feeding jejunostomy was carried out. However postoperatively patient developed progressive pulmonary insufficiency with features of sepsis and expired on the nineteenth day following a bout of massive haematemesis. Corrosive agents when taken in considerable amount mixed with other fluids can lead to full thickness small bowel necrosis with relative sparing of the proximal gastrointestinal tract.

Keywords

Corrosive Injury, Acid Ingestion, Bowel Necrosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. P. Thornton, “Surgical Management of corrosive Gastric Injuries,” Journal of the National Medical Association, Vol. 66, No. 1, 1974, pp. 53-55.
[2]	J. B. Dilawari, S. Singh, P. N. Rao and B. S. Anand, “Corrosive Acid Ingestion in Man—A Clinical and Endoscopic Study,” Gut, Vol. 25, No. 2, 1984, pp. 183-187. doi:10.1136/gut.25.2.183
[3]	K. Ramasamy and V. V. Gumaste “Corrosive Ingestion in Adults,” Journal of Clinical Gastroenterology, Vol. 37, No. 2, 2003, pp. 119-124. doi:10.1097/00004836-200308000-00005
[4]	S. Sharma, P. R. Debnath, L. D. Agarwal and V. Gupta, “Gastric Outlet Obstruction without Esophageal Involvement: A Late Sequelae of Acid Ingestion in Children,” Journal of Indian Association of Pediatric Surgeons, Vol. 12, No. 1, 2007, pp. 47-49. doi:10.4103/0971-9261.31094
[5]	P. Cattan, N. Munoz-Bongrand, T. Berney, B. Halimi, E. Sarfati and M. Celerier, “Extensive abdominal surgery after caustic ingestion,” Annals of Surgery, Vol. 231, No. 4, 2000, pp. 519-523. doi:10.1097/00000658-200004000-00010
[6]	Q. Zeng, H. Zhou, X. Zheng, Z. Li, M. Zhou, S. Han, et al., “Total Gastrointestinal Tract Necrosis after Ingesting a Considerable Amount of Hydrochloric Acid,” Journal of Gastrointestinal Surgery, Vol. 13, No. 3, 2009, pp. 578-80. doi:10.1007/s11605-008-0524-9
[7]	O. Boybeyi, I. Karnak, F. C. Tanyel and M. E. Senocak, “Management of Unusually Extensive Esophagogastric Corrosive Injuries: Emergency Measures and Gastric Reconstruction,” Journal of Pediatric Surgery, Vol. 44, No. 5, 2009, pp. 1022-1026. doi:10.1016/j.jpedsurg.2009.02.001
[8]	J. M. Chang, M. H. Wu, W. W. Lai, M. Y. Lin, Y. F. Tsai, I. L. Hsu, et al., “Acid Corrosive Injury in Patients with a History of Partial Gastrectomy: Outcome Analysis,” Digestive Surgery, Vol. 24, No. 3, 2007, pp. 202-207. doi:10.1159/000102900