Browsing by Author "Scriba, Matthias Frank"

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Open Access
    An overview of adult corrosive ingestion injuries in a sub-Saharan African setting
    (2025) Scriba, Matthias Frank; Jonas, Eduard; Chinnery, Galya
    BACKGROUND Corrosive ingestion remains an important global pathology with high associated morbidity and mortality. Data on the acute management of adult corrosive injuries from sub-Saharan Africa (SSA) is scarce, with international investigative algorithms, relying heavily on computerised tomography (CT), having limited availability in this setting. AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness (FT) necrosis and mortality. METHODS A retrospective analysis of a prospective corrosive injury registry (1st March 2017 – 31st October 2023) was performed to include all adult patients with acute corrosive ingestion managed at a single, academic referral centre in Cape Town, South Africa. Patient demographics, corrosive ingestion details, initial investigations, management, and short-term outcomes were described using simple descriptive statistics while univariate analyses with receiver operator characteristic area under the curve (ROC AUC) were used to identify factors predictive of FT necrosis and short-term mortality on admission. CT (grade III corrosive CT grading), endoscopy (Zargar IIIB), and blood gas findings were specifically analysed for FT necrosis prediction performance. RESULTS A total of 100 patients were included, with a mean age of 32 years (SD: 11.2 years) and a male predominance (65.0%). The majority (73.0%) were intentional suicide attempts. Endoscopy on admission was the most frequent initial investigation performed (95 patients), while only 17 were assessed with CT. A chest X-ray (CXR) was performed in 82 patients and only one patient was initially assessed using a contrast swallow examination. Neither CXR nor early contrast swallow findings directly influenced the management in any of these cases. Twenty patients required acute surgery with 17 having full thickness necrosis at surgery, of which eleven underwent emergency resection and six were palliated. Five patients underwent oesophagogastrectomy and five total gastrectomy, with two requiring extended resections (pancreas-preserving duodenectomy and proximal jejunal resection). Thirty-day mortality was 14,0% and morbidity 27,0%. Patients with full thickness necrosis at surgery and those with an established perforation had a 30-day mortality of 58.8% and 91,0%, respectively. Full thickness necrosis was associated with a cumulative survival of 17.6% at 2 years. Univariate analyses with ROC AUC showed admission endoscopy findings, CT findings, and blood gas findings, specifically pH, base excess, and lactate, to all have significant predictive value for full thickness necrosis, with endoscopy proving to have the best predictive value (AUC 0.850). CT and endoscopy findings were the only factors predictive of early mortality, with CT performing better than endoscopy (AUC 0.798 vs 0.759). CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality. Locally, early endoscopy remains the mainstay of severity assessment, but referral for CT imaging should be considered especially when blood gas findings are abnormal.
  • Thumbnail Image
    Item
    Open Access
    Foley catheter balloon tamponade for penetrating neck injuries at Groote Schuur hospital: an update
    (2020) Scriba, Matthias Frank; Navsaria, Pradeep
    Introduction Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is an effective, readily available and easy-to-use technique. This study aims to audit the technique and highlight current investigative and management strategies. Methods All adult patients (18 years and older) with PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were included. Data was captured from an approved electronic registry and analysed. Analysed parameters included demographics, major injuries, imaging, management and outcomes. Results Over the study period a total of 628 patients with PNI were managed at GSH, in which 95 patients (15.2%) FCBT was utilised. The majority were men (98%) with an average age was 27.9 years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH (1.1% prehospital, 45.3% at clinic level and 34.7% at district hospital level). Computerised tomography (CT) angiography was used in 92.6% of patients, while 8 patients (8.4%) required formal angiography. Of these, 2 were purely diagnostic and 6 were performed for definitive endovascular management. A total of 34 arterial injuries (19 major and 15 minor) were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate at haemorrhage control. Thirteen (13.7%) patients requried open neck surgery. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48-72 hours post injury. Only two of these had bleeding on catheter removal. Fifteen patients required ICU admission. A total of 36 separate morbidities were documented in 28 patients (29.5%). There were 4 deaths (4.2% mortality rate), with only one of these attributable to uncontrolled haemorrhage from the neck wound. Conclusion This large series shows the current use of FCBT for PNI. It highlights ease of use, high rates of success at haemorrhage control (97%) and good outcomes with the technique. Venous injuries and minor arterial injuries can be managed with this technique definitively.