Published online Nov 5, 2024. doi: 10.4292/wjgpt.v15.i6.99097
Revised: September 6, 2024
Accepted: September 14, 2024
Published online: November 5, 2024
Processing time: 103 Days and 12.7 Hours
Corrosive ingestion remains an important global pathology with high morbidity and mortality. Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce, with international investigative algorithms, relying heavily on computed tomography (CT), having limited availability in this setting.
To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness (FT) necrosis and morta
A retrospective analysis of a prospective corrosive injury registry (March 1, 2017–October 31, 2023) was performed to include all adult patients with acute corrosive ingestion managed at a single, academic referral centre in Cape Town, South Africa. Patient demographics, corrosive ingestion details, initial investigations, management, and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs (ROC AUC) were used to identify factors predictive of FT necrosis and 30-day mortality.
One-hundred patients were included, with a mean age of 32 years (SD: 11.2 years) and a male predominance (65.0%). The majority (73.0%) were intentional suicide attempts. Endoscopy on admission was the most frequent initial investigation performed (95 patients), while only 17 were assessed with CT. Seventeen patients had full thickness necrosis at surgery, of which eleven underwent emergency resection and six were palliated. Thirty-day morbidity and mortality were 27.0% and 14.0%, respectively. Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8% and 91.0%, respectively. Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%. Multivariate analyses with ROC AUC showed admission endoscopy findings, CT findings, and blood gas findings (pH, base excess, lactate), to all have significant predictive value for full thickness necrosis, with endoscopy proving to have the best predictive value (AUC 0.850). CT and endoscopy findings were the only factors predictive of early mortality, with CT performing better than endoscopy (AUC 0.798 vs 0.759).
Intentional corrosive injuries result in devastating morbidity and mortality. Locally, early endoscopy remains the mainstay of severity assessment, but referral for CT imaging should be considered especially when blood gas findings are abnormal.
Core Tip: Management of acute adult corrosive injuries remains internationally under-reported, but specifically in sub-Saharan Africa. This large series of 100 patients highlights the high rates of morbidity and mortality, especially when full thickness necrosis is established. Predicting necrosis on admission is challenging, with international guidelines proposing computed tomography (CT) as the investigation of choice. With limited availability of CT, endoscopy still performs well in our setting. CT should be considered in patients with suspected severe corrosive injury with abnormal findings on blood gas (pH, base excess, and lactate) serving as accurate and practical markers of severity in a low-resource setting.