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A case of total esophago-gastro-duodeno-jejunectomy and partial pancreatectomy for lye burns, and reconstruction with colon interposition.

We report a unique case of extensive surgery for severe lye burns. It included total esophago-gastro-duodeno-jejunectomy and partial pancreatectomy. We were unable to find a similar successfully treated case in English-language literature. Ninety-one days after the initial emergency surgery, the patient successfully underwent reconstruction of alimentary tract with isoperistaltic left colon interposition between proximal cervical esophagus and ileum.

Burns, Chemical↗

Unexpected metabolic acidosis in severe lye poisoning.

Prolonged metabolic acidosis developed in a 38-year-old patient suffering from severe peroral liquid lye poisoning without shock syndrome. Metabolic acidosis was caused by lactic acid. The combination of increased lactic acid production in the marginal regions of the necrotic intestinal areas and impaired lactate removal by the liver were most probably responsible for this lactic acidosis.

Acidosis↗

[Limitations of rehabilitation possibilities in lye burns of the face].

Acute management of lye burns of the face has to include continuous irrigation and earliest possible necrectomy. Wound coverage by split thickness skin grafts was quite often found to be problematic for frequent occurrence of secondary necroses. Loss of eyelids is difficult to tackle, since complicated transposition flaps would then be required, with no guarantee of satisfactory cosmetic result.

Adult↗

[Limits in the possibilities for rehabilitation of lye burns of the face].

Several cases of lye burns of the face are presented. The most common causes are explosions. Primary treatment includes continuous irrigation, debridement by dermabrasion and split-thickness skin grafts. The problems resulting from deep burns with loss of the eyelids and exposure of the alar cartilages, can be solved satisfactorily only with distant pedicled flaps.

Accidents, Occupational↗

Sucralfate therapy for lye-induced esophagitis.

Sucralfate is a recently introduced drug that has received acceptance as a nonsystemic, locally active antiulcer agent used in the treatment of duodenal ulcer disease. In addition, sucralfate has been used for the treatment of gastric ulcer and a variety of other gastrointestinal diseases. However, the use of sucralfate to treat caustic esophagitis has not been clinically investigated, and a review of the literature yielded scant information (1). Herein, we report our experience with sucralfate in the treatment of a case of lye-induced esophagitis.

Adult↗

Lye ingestion. Clinical patterns and therapeutic implications.

Conventional treatment of caustic esophagitis consists of early endoscopy to the first site of injury followed by antibiotic and steroid therapy, with early mechanical dilatation to prevent stricture formation. The failure of this approach in two recent patients led us to review our overall experience with the management of patients who had ingested lye or other caustic substances. Of 42 patients treated at the Santa Clara Valley Medical Center between 1970 and 1980, seven sustained severe esophageal burns. All had intractable strictures despite steroids, antibiotics, and, in three cases, attempts at dilatation. We conclude that patient survival should not be jeopardized by overly aggressive attempts to salvage an extensively damaged esophagus. Such attempts will probably prove both futile and dangerous, and effective re-establishment of oral-intestinal continuity is now possible by a variety of techniques.

Adolescent↗

Barrett's epithelium complicating lye ingestion with sparing of the distal esophagus.

We report a patient with a history of lye ingestion in whom a band of ectopic gastric mucosa is associated with a stricture of the mid-esophagus. Specialized columnar epithelium (a type of Barrett's epithelium) developed along the edges of this band. This specialized columnar epithelium is separated from the mucosa of the stomach by a continuous sheet of normal stratified squamous epithelium. Heretofore, Barrett's epithelium involving the middle esophagus has been reported only as the proximal extension of a sheet of columnar mucosa lining the entire distal esophagus. The development of specialized columnar epithelium in this setting suggests that local factors besides gastroesophageal reflux may be involved in the pathogenesis of Barrett's epithelium.

Adult↗

[Aqueous humor pH in experimental lye burns and influence of different treatment measures (author's transl)].

300 rabbit corneas were burned for 1 minute by applying a filter paper of 10 mm diameter soaked in different concentrations of NaOH. The aqueous humor pH was then measured at certain time intervals and after different treatment methods until the physiologic pH of 7.6 was reached. The results were statistically analysed. Group 1, 2 and 3 were burned in 1n NaOH, 3n NaOH, and 6n NaOH respectively without any treatment. In these groups a "therapeutic" pH-level of 8.5 was measured on an average 0.5, 2.5 and 5 hours after the burn (Table 1 and Fig. 2). Group 4 and 5 again were burned with 6n NaOH. In group 4 the burn was followed by constant irrigation with physiologic saline solution by means of the Morgan Therapeutic Lens (Fig. 1a and b). With this regimen a pH of 8.5 was reached after 2.5 hours (Table 1 and Fig. 3). In group 5 the physiologic saline solutions was replaced by a buffer solution (Isogutt) and a pH of 8.5 was measured after only one hour (Table 1 and Fig. 3). Based upon these results it is felt that severe lye burns should be treated by constant irrigation with a buffer solution for several hours. A treatment that can easily be performed by use of the Morgan Therapeutic Lens.

Animals↗

Patterns of streamwater acidity in Lye Brook Wilderness, Vermont, USA.

Under the United States Clean Air Act Amendments of 1977, a class I designation safeguards wilderness areas from the negative effects of new sources of air pollution. We monitored streamwater chemistry in the class I Lye Brook Wilderness in southwestern Vermont from May 1994 through August 1995. Stream samples were collected biweekly at nine sampling locations throughout the wilderness and were analyzed for major cations and anions, dissolved organic carbon, pH, and acid-neutralizing capacity. Eight of nine sites sampled had mean annual acid neutralizing capacity values below zero. During the study period, decreases in streamwater acid neutralizing capacity values were caused primarily by SO(4)(2-). At some sites, however, NO(3) (-) and naturally occurring, weak organic acids were seasonally important. During high discharge, the low pH and high concentrations of inorganic monomeric Al were at levels that are toxic to acid-sensitive aquatic species. Watershed mass balances were calculated to determine annual gains or losses for measured ions. These budgets indicate that S inputs and outputs were nearly equal, there was a net loss of base cations, and a net gain in N. How long these watersheds can continue to assimilate additional N inputs is unknown.

Carbon↗