Ana L. Romero¹, Jesus Romero^1,, Sherif Elkattawy², Nikhita Sachdeva³, Fareeha Abid¹, Hardik Fichadiya¹, Muhammad Atif Masood Noori¹, Islam Younes¹, Shruti Jesani¹, Ricardo Rodriguez¹

Caustic ingestion results in a wide range of injuries from mucosal erythema to transmural necrosis and viscus perforation, depending on the nature, amount, and time of contact of the substance with the gastrointestinal mucosa. Esophagogastroduodenoscopy (EGD) is considered the gold standard not only for the diagnosis but also for the guide in management. Here in we report a case of a 44-year-old male who presented to ER with complaints of abdominal pain and coffee ground emesis after ingestion of an acid cleaner in the setting of a suicide attempt. CT chest and abdomen demonstrated a small amount of fluid around the distal esophagus and diffuse gastric sub-mucosal edema with no pneumo-mediastinum. EGD showed severe caustic esophagitis and necrosis, gastritis, and mucosal necrosis. Gradually patient transitioned from parenteral nutrition to a liquid diet. Given patient continued to have symptoms of dysphagia, a follow-up EGD was performed which showed erosive esophagitis and severe intrinsic stenosis 26.5 cm from the incisors. The patient underwent gastrostomy as an attempt failed to traverse the stenosis. Post-procedure, the patient started spiking fever with leukocytosis and was found to have an intra-abdominal abscess as evidenced by CT abdomen for which he had emergent laparotomy and evacuation of abdominal abscess and replacement of gastrostomy tube. This case represents the complicated nature of ingesting acidic fluid. It also highlights the importance of considering of overall worse prognosis with that of alkali as compared to acid.

gastrostomy, esophagogastroduodenoscopy, intra-abdominal abscess, esophageal stricture, caustic acid ingestion