Ingestion de produits caustiques chez l'adulte

Massive accidental or suicidal ingestion of corrosive agents results in severe upper gastrointestinal tract injuries requiring specific surgical and intensive care management. Following caustic ingestion, mortality rate may reach 10% and is strictly related to the delay between ingestion and the introduction of adequate treatments. The most frequently involved agents are caustic soda-based strong alkali (pH > 12) strong acids (pH < 2), and oxidants. Corrosive ingestion usually leads to injuries of the aerodigestive pathways, but in some cases, systemic toxicity may occur. Provoked vomiting, nasogastric tube positioning, attempts to neutralize or dilute the corrosive agent, oral medication to protect the gastric mucosa may worsen the patient conditions and should be avoided in the emergency setting. Emergency esophagogastric endoscopy is the key examination for subsequent management. Systematic endoscopic evaluation is required as no correlation exists between the extent of gastro-intestinal involvement and the severity of oropharyngeal injuries or clinical symptoms. Moreover, decision to perform emergency esophago-gastrectomy, jejunostomy for temporary enteral nutrition or only clinical observation relies on endoscopy findings. Concomitant injuries of trachea and/or the main bronchus due to aspiration or diffusion of the corrosive substance is an ominous finding increasing mortality rate. Emergency esophagogastrectomy or the development of esophageal strictures after conservative emergency management requires reconstructive surgery to restore the digestive continuity. Reconstruction relies on esophageal replacement usually by a colonic substitute; treatment of associated pharyngeal injuries relies on colopharyngoplasty. Control of the underlying psychiatric disease is a key factor for success in patients with caustic injuries.