An overview of adult corrosive ingestion injuries in a sub-Saharan African setting

Scriba, Matthias Frank

An overview of adult corrosive ingestion injuries in a sub-Saharan African setting

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Division of General Surgery

Faculty

Faculty of Health Sciences

Abstract

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.