The Dire yet Regrettable Cause of Upper Gastrointestinal Bleeding: Caustic Substance Ingestion

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

¹Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ, USA.

²Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ, USA.

³Internal Medicine Department, St. George University, Grenada.

Cite this paper:
Ana L. Romero, Jesus Romero, Sherif Elkattawy, Nikhita Sachdeva, Fareeha Abid, Hardik Fichadiya, Muhammad Atif Masood Noori, Islam Younes, Shruti Jesani and Ricardo Rodriguez. The Dire yet Regrettable Cause of Upper Gastrointestinal Bleeding: Caustic Substance Ingestion. American Journal of Medical Case Reports. 2023; 11(6):110-112. doi: 10.12691/ajmcr-11-6-2

Abstract

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.

Keywords:
gastrostomy esophagogastroduodenoscopy intra-abdominal abscess esophageal stricture caustic acid ingestion

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References:

[1]	Poley, J.W., Steyerberg, E.W., Kuipers, E.J., et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004, 60:372-377.
[2]	Ertekin, C., Alimoglu, O., Akyildiz, H., Guloglu, R., Taviloglu, K. The results of caustic ingestions. Hepatogastroenterology. 2004, 51:1397-1400.
[3]	Holstege, C.P. Hydrochloric acid. In: Wexler P, ed . Encyclopedia of Toxicology. Oxford. Elsevier Ltd, UK, 2005. 538:40.
[4]	Cheng, H.T., Cheng, C.L., Lin, C.H., et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 20088, 31-2008.
[5]	Chibishev, A., Pereska, Z., Chibisheva, V., Simonovska, N. Corrosive poisonings in adults. Mater Sociomed. 2012, 24:125-130.
[6]	Alan, H., Hall, D. J., Danièlle, H., Laurence, M., Patrice, J., Bernard, M. Corrosive substances ingestion: a review. Critical Reviews in Toxicology, 2019. 49. 8:637-669.
[7]	Ramasay, K., Gumaste, V.V. Corrosive ingestion in adults. J Clin Gastroenterol. 2003:110-124.
[8]	Robustelli, U., Bellotti, R., Scardi, F., et al. Management of corrosive injuries of the upper gastrointestinal tract. Our experience in 58 patients. G Chir. 2011, 32:188-193.
[9]	Chiu, H.M., Lin, J.T., Huang, S.P., Chen, C.H., Yang, C.S., Wang, H.P. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with an upper endoscopy. Gastrointest Endosc. 2004, 60:827-833.
[10]	Schaffer, S.B., Hebert, A.F. Caustic ingestion. J La State Med Soc. 2000, 152:590-596.
[11]	Rossi, A. Acute caustic ingestion: state of art and new trends. Journal of gastroenterology and hepatology research. 2015, 4:1501-1506.
[12]	De Lusong, M.A.A., Timbol, A.B.G., Tuazon, D.J.S. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther. 2017, 8:90-98.