Oesophagogastrectomy and pancreatoduodenectomy for caustic injury

Abstract

PD can save the lives of patients with caustic injuries extending beyond the pylorus, but has poor functional outcome. Immediate pancreatic duct reconstruction should be preferred to duct occlusion to decrease the rate of pancreatic complications.

The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent

“…We also recorded a significantly higher incidence of pathologically proven full-thickness duodenal wall necrosis after acid ingestion. This finding is in accordance with the high proportion of acid ingestion reported by our group after pancreatoduodenectomy for caustic injuries [16]. Of note, the incidence of early oropharyngeal burns and of pharyngeal strictures was similar after ingestion of acids and alkalis; occurrence of pharyngeal injuries is most likely to be conditioned by the pattern of ingestion (hesitation before swallowing, provoked vomiting) rather than the nature of the ingested agent [15].…”

Emergency pancreatic surgery—demanding and dangerous

“…These publications have shown that salvage resections are associated with increased morbidity and mortality compared to elective procedures. In contrast, very few data are available on primary emergency pancreas resections as these procedures are rarely performed [10][11][12][13][14]. In the present study, we could show that emergency pancreas operations account to a frequency below 1 % in a tertiary referral center with a high overall number of pancreatic operations and full 24/7 emergency service.…”

“…Most publications on primary emergency pancreatic operations are dealing with the management of pancreatic injuries following blunt or penetrating abdominal trauma [6][7][8][9]. Beyond these publications on trauma patients, the available literature mainly includes case reports or small patient series [10][11][12][13][14] and show that there is heterogeneity in the indications leading to emergency pancreas operations as well as in the performed surgical procedures [10,11]. However, considerable morbidity and mortality rates have been reported.…”

Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review

“…Moreover, a large series of 18 patients affected by caustic injuries in which an EPD was associated with oesophagogastrectomy has been reported by Lefrancois, with a mortality rate of 39% (N ¼ 7/18) [49].…”