Corrosive injuries of the esophagus and stomach are a result of accidental/ suicidal/ homicidal ingestion of acid/ alkali corrosives, the most common being toilet cleaners (Harpic/ Domex, etc). This results in burn injuries to the internal lining/ whole thickness of these organs, causing symptoms of problems with swallowing/ digestion. At times they need emergency surgery for full-thickness burns causing devitalization/ rupture of respective organs. But the initial insult is usually managed medically and an endoscopy to assess the extent of the injury and subsequent dilations to prevent the narrowing of the esophagus. Some patients would require access for feeding- usually a feeding tube jejunostomy. Healing in the body occurs by fibrosis and this results in the narrowing of organs involved- either the esophagus/ stomach or both. Subsequent treatment depends on the extent of their involvement.
When such patients are seen early and are compliant with regular treatment and follow-ups, endoscopic dilations offer significant benefits in preventing/ treating esophageal strictures. But if the strictures are long segment/ tight/ not amenable to endoscopic dilations, the esophagus needs replacement, usually retaining and bypassing the native esophagus. Since the stomach too is usually damaged in such patients, either free small bowel segment/ colonic transposition are the usable alternatives, the latter being used more often. Nearly ¾ of the colon is harvested based on a single artery (usually the left colic artery) and can reach the required length in the neck from the abdomen. Ischemia of harvested colon is a specific, dangerous, and life-threatening complication of this procedure. If the quality of the esophagus in the neck is not good, it may need regular dilations of the site of joining after surgery. If the site of joining in the neck is very high, the risk of aspiration exists with a resultant chest infection and may need tracheostomy as a safety valve at least temporarily after surgery. There exists a risk of injury to nerves responsible for voice production, which is usually one-sided and well compensated by the opposite side ones.