The Natural History of Liquid Lye Ingestion

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Abstract
Fatal suffocating bronchial artery hemorrhage occurred in a patient recovering satisfactorily following total gastrectomy for gastric necrosis occurring after a suicide attempt by ingestion of liquid lye. The lye created a punched-out hole in the membranous trachea adjacent to the totally necrotic esophagus. The natural history of liquid lye ingestion, illustrated by this clinical course and similar cases from the literature, is a new phenomenon caused by the recent introduction of liquid lye kitchen drain cleaners. It includes (1) rapid transmural gastric and esophageal necrosis and (2) spread of necrosis to contiguous organs. Optimal management of patients should include (1) exploratory laparotomy after roentgenographic confirmation of injury, (2) total gastrectomy for gastric necrosis, (3) right-sided thoracotomy when the distal part of the intra-abdominal esophagus is questionably viable, (4) esophagectomy for esophageal necrosis, and (5) delayed restoration of gastrointestinal tract continuity with colon interposition.

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