Predictors of associated intra-abdominal visceral injuries in patients with extensive acid corrosive ingestion and the surgical outcomes

To delineate the pre-operative clinical indicators of associated injuries of intraabdominal viscera in areas other than the upper alimentary tract among the patients with extensive acid corrosive injuries, and the causes of death. Fifty-four patients who suffered from extensive acid corrosive injuries between July 1988 and February 2000 and underwent esophagogastrectomy (group A), esophagogastroduodenectomy with partial jejunectomy (group B), or laparotomy (group C) only due to extensive organ damage in a tertiary center were included in the data analysis. These patients ingested liquid acid, mostly hydrochloric acid, in attempted suicides or by accident with extensive corrosive injuries. Patient data and clinical presentations from the time of admission to discharge or death were retrospectively reviewed using hospital records. Both univariate analysis and multiple logistic regression were performed to determine the significant pre-operative indicator of multiple injuries. Mortality rates were 21% (6/29) in group A, 50% (8/16) in group B and 100% (9/9) in group C respectively in a total of fifty-four patients. Half of the patients (27/54) had associated intra-abdominal visceral damage, with the percentages of 38% (11/29) in group A, 50% (8/16) in group B, and 89% (8/9) in group C respectively (p=0.005). Nineteen (19/27, 70%) of these patients died after surgery compared to 4 (4/27, 15%) of those without associated injuries (p<0.001). The major causes of death were multiple organ failure (n=15) and sepsis (n=5), and the time of death ranged from 1 to 64 days after surgery. Univariate analysis showed that the severity of coma (severe versus the others) and shock index (<1 versus ≥1) at admission were significant predictors for multiple injuries (p=0.005, and 0.03, respectively). Multiple logistic regression showed that presence of severe coma was the only significant indicator of associated intra-abdominal visceral injuries (p=0.04). Surgery remains the only way to save the life of the patients with extensive corrosive injuries. Those patients with associated corrosive injuries of the viscera other than in the upper alimentary tract were at greater risk of death compared to those without multiple injuries. Presence of severe coma, and higher shock index at admission were important indications of multiple injuries and subsequent death.