Citation

Mensier A, Onimus T, Ernst O, Leroy C, Zerbib P. J. Visc. Surg. 2020; 157(6): 469-474.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.jviscsurg.2020.02.001

PMID

32088182

Abstract

INTRODUCTION: Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions.
PATIENTS AND METHODS: In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results.
RESULTS: Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis.
CONCLUSION: CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.

Language: en

Keywords

Humans; Female; Male; Middle Aged; Prospective Studies; Tomography, X-Ray Computed; Stomach; Suicide, Attempted; Algorithms; Necrosis; Computed tomography; Caustics; Gastritis; Caustic lesions; Burns, Chemical; Caustic ingestions; Gastroscopy