Surgical implications of acid ingestion.

Ingestion of mineral acid may be accidental or intentional. This form of corrosive usually sears the esophageal mucosa only to produce major injury to the stomach. The prepyloric antrum is almost always injured, but the fundus and cardia may be involved if the stomach is empty at the time of ingestion. Clinically, significant esophageal injury occurs in less than 20 per cent. Initial treatment is supportive, with early operation reserved for patients with severe ingestion in whom gastric necrosis rapidly ensues. In the more typical patient, however, late gastric outlet obstruction still makes surgical therapy mandatory. Subtotal gastrectomy with Billroth I reconstruction is usually possible and is the treatment of choice. Total parenteral nutrition is a useful adjunct.