Abstract
In the present study, we have described two possible approaches in the management of caustic injuries. Diagnostic emergency laparoscopy can be used for exploration in case of stable patients with Zargar’s 3a gastric lesions and equivocal peritoneal signs. On the other hand, in case of patients with Zargar’s 3b gastric lesions with perforation, diffuse peritonitis and hemodynamic instability, a new possible technique is described as an option to be used in such extensive caustic injuries: duodenal damage control with “4-tubes ostomy” for duodenal and jejunal wash-out of the caustic agent. The aim of this simple technique is to wash-out the caustic agent from the duodenum when the duodenum and Treitz are not yet gangrenous/perforated, as well as to avoid duodenal primary closure and jejuno-jejunal anastomosis over damaged tissues.
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Author contributions
Dr. Salomone Di Saverio MD was the operating surgeon and developed the surgical technique. Dr. Andrea Biscardi MD was the assisting surgeon. Dr. Salomone Di Saverio has written the manuscript and described the technique. All authors revised and approved the final version of the manuscript.
Acknowledgments
The Authors would like to thank Dr. Franco Baldoni, former Director of the Emergency and Trauma Surgery in Maggiore Hospital in the decade 2000–2010, for having been the master of all of us for Damage-Control Surgery and Techniques. Special thanks and wholehearted appreciation are for Dr. Serena Galli, TSRM, who has drawn the anatomy of the scheme of the technique represented in Fig. 10 with her excellent painting mastery. Thanks also to Mrs. Antonietta Petrozzi RN, for taking intraoperative pictures.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Di Saverio, S., Biscardi, A., Piccinini, A. et al. Different possible surgical managements of caustic ingestion: diagnostic laparoscopy for Zargar’s grade 3a lesions and a new technique of “Duodenal Damage Control” with “4-tubes ostomy” and duodenal wash-out as an option for extensive 3b lesions in unstable patients. Updates Surg 67, 313–320 (2015). https://doi.org/10.1007/s13304-015-0313-4
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DOI: https://doi.org/10.1007/s13304-015-0313-4