Caustic burns of the esophagus: Experience with 143 patients

From 1968 to 1988, 143 patients with caustic burns of the esophagus were observed. There were 72 lesions from acids, 55 from alkali and 16 from unidentified agents. In about half the patients the ingestion was accidental. 37 patients presented with a segmentary esophageal lesion, 13 with a lesion involving the whole esophagus, and the remaining patients with multiple esophago-gastric lesions. The incidence of associated gastric lesions was significantly higher when the corrosive agent was an acid (p < 0.001). Two patients underwent emergency total gastrectomy because of massive gastric necrosis. 63 patients underwent endoscopic dilatations, and in 59% of them this treatment alone was effective in relieving dysphagia without need for surgical operation. Overall, 49 esophageal reconstructions were performed and the esophageal stricture was by-passed in 26 cases. The most commonly performed operation was a cervical esophagocoloplasty using the left colon transposed to the neck via a substernal route. Seven patients, who presented with an anastomotic stricture refractory to dilatations following an esophageal reconstruction performed elsewhere, underwent an operation limited to the anastomosis. The overall postoperative mortality rate was 1.8%. Cervical anastomotic leaks were observed in 7 patients (12.5%) and healed with conservative treatment. The long term results of surgery are satisfactory in all patients.