Author: Abdul Sami Naseri
Abstract
Background: Caustic substance ingestion is an important gastrointestinal emergency that may cause acute and delayed injury to the upper gastrointestinal tract. The severity of injury depends on several factors, including the nature of the substance, concentration, amount ingested, and duration of tissue exposure. Complications may include gastrointestinal bleeding, perforation, esophageal stricture, gastric outlet obstruction, and death. Local data regarding the clinical characteristics and complications of caustic ingestion in Afghanistan remain limited.
Objective: To determine the frequency and types of complications following caustic substance ingestion among adult patients admitted to the Department of Internal Medicine of Abu Ali Sina Balkhi Regional Hospital during 1404 Solar Hijri.
Methods: A descriptive retrospective case-series study was conducted among adult patients admitted with caustic substance ingestion during 1404 Solar Hijri.All eligible patients whose medical records contained the required information were included using total/consecutive sampling. Data were collected regarding age, sex, type of caustic substance, intent of ingestion, time to hospital presentation, length of hospital stay, upper gastrointestinal bleeding, esophageal stricture, pyloric stricture, esophageal or gastric perforation, and treatment outcome. Data were analyzed using descriptive statistics and are presented as frequencies, percentages, means, and standard deviations.
Results: A total of 84 adult patients were included. The mean age was 25.92 ± 11.91 years, with a median age of 22 years. Sixty-three patients (75.0%) were female and 21 (25.0%) were male. The majority of patients were 18–29 years old (69; 82.1%). All recorded ingestions were intentional. Acidic substances were ingested by 66 patients (78.6%), while alkaline substances were involved in 18 (21.4%). The mean time from ingestion to hospital presentation was 2.22 ± 1.00 hours, and the mean hospital stay was 3.07 ± 1.90 days.
Upper gastrointestinal bleeding, documented as hematemesis at presentation, occurred in 20 patients (23.8%). Esophageal stricture three weeks after ingestion was documented in 3 patients (3.6%), while pyloric stricture was documented in 2 patients (2.4%). Esophageal or gastric perforation occurred in 2 patients (2.4%). Three patients (3.6%) died. Four patients (4.8%) were referred to an appropriately equipped health facility after developing complications during the three-week follow-up period. Seventy-seven patients (91.7%) were documented as recovered.
Conclusion: In this hospital-based series of adult caustic ingestion, patients were predominantly young adults and female, and all recorded ingestions were intentional. Acidic substances were more frequently involved than alkaline substances. Upper gastrointestinal bleeding was the most frequently documented complication, while esophageal stricture, pyloric stricture, perforation, and mortality occurred less frequently. The findings emphasize the importance of early presentation, close observation, and follow-up for delayed gastrointestinal complications.