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DOI: 10.1055/s-2007-961806
© Georg Thieme Verlag KG Stuttgart · New York
Akzidentielle und suizidale Verätzungen des oberen Gastrointestinaltraktes
Accidental and Suicidal Caustic Gastric IngestionPublikationsverlauf
Publikationsdatum:
23. März 2007 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200701/lookinside/thumbnails/10.1055-s-2007-961806-1.jpg)
Zusammenfassung
Das Verschlucken von Säuren oder Laugen kann schwerwiegende Schäden verursachen. Am Anfang steht die übliche Notfalltherapie (Sicherung der Atemwege, Volumensubstitution, Analgesie) im Vordergrund. Diagnostikum der Wahl ist die frühe Endoskopie. Von der Gabe von Wasser oder Milch zur Verdünnung oder Aktivkohle wird abgeraten. Der Nutzen der systemischen Gabe von Steroiden ist nicht belegt, eine Antibiotikaprophylaxe bei höhergradigen Verätzungen erscheint sinnvoll. Wichtigster Prognosefaktor bezüglich der initialen Mortalität ist die verspätete Diagnose und Behandlung transmuraler ösophagogastraler Nekrosen, deshalb sollte beim Hinweis auf eine Perforation eine schnellstmögliche chirurgische Exploration durchgeführt werden. Da es trotz endoskopischen Befundes oft schwierig ist, intraoperativ das genaue Ausmaß der Verletzung abzuschätzen, müssen im Zweifel alle möglicherweise von höhergradigen Verätzungen betroffene Abschnitte reseziert werden. Die Rekonstruktion erfolgt frühestens nach 4 Monaten. In Anhängigkeit von der initialen Resektion kann dann die Rekonstruktion geplant werden (z. B. Magenhochzug, Koloninterponat). Strikturen sind das häufigste Problem im Langzeitverlauf und werden im Regelfall interventionell therapiert. Da aber besonders höhergradige Strikturen auch auf wiederholte Dilatationen therapierefraktär sind, sollte hier frühzeitig eine Resektion in Erwägung gezogen werden. Eine regelmäßige endoskopische Nachsorge ist aufgrund der deutlich erhöhten Gefahr der Entwicklung eines Ösophaguskarzinoms zu empfehlen.
Abstract
Caustic ingestion can cause sever damages. Immediate management should be directed to airway securing, intravenous fluid replacement and pain relief. Early endoscopy is regarded as the most appropriate method based on which further clinical decisions are made. The effectiveness of dilution by milk or water has not been proven and might aggravate the damage. The use of systemic corticosteroids should also be abandoned as they do not prevent the development of strictures and may cause serious adverse effects. The most important prognostic factor concerning early mortality is the delayed diagnosis and therapy of full thickness esophageal or gastric necrosis. Patients with evidence of perforation require immediate surgery. Since it can be very difficult to classify the exact extent of damage intraoperatively according to the endoscopic findings, a resection of all high grad damaged segments should be performed in doubt. Reconstructive surgery should not be performed earlier then 4 months after the initial event. The used technique depends on the extent of the initial damage and surgery. Development of strictures is the most important physical consequence in burned areas in survivors. Short strictures are mainly treated by endoscopic dilatation. In cases of higher graded strictures, when repeated dilatations are often ineffective, early resection should planned. Because of the high incidence of esophageal cancer among victims of caustic strictures, routine endoscopic follow up is recommended.
Schlüsselwörter
Säure - Lauge - Verätzung - Komplikation - Chirurgie - Therapie
Key words
Acid - lye - caustic ingestion - complication - surgery - therapy
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Korrespondenzadresse
PD Dr. med. Robert Obermaier
Albert-Ludwigs-Universität Freiburg
Chirurgische Universitätsklinik
Abteilung für Allgemein- und Viszeralchirurgie
Hugstetter Str. 55
79106 Freiburg
Telefon: +49/761/270 26 97
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