Caustic injury to the Oesophagus can result in recalcitrant stricturing not amenable to endoscopic therapy, resulting in Oesophagectomy.
We present a case of a 59 yo male who underwent Mckeown Oesophagectomy for accidental Alkaline exposure resulting in a long tight Oesophageal stricture.
The patient presented to our hospital with odynophagia 30 minutes after accidentally ingesting 2 mouthfuls of 25% NaOH in an unlabelled water bottle. He underwent diagnostic endoscopy and Nasojejunal feeding initially, followed later by Insertion of feeding jejunostomy tube. Followup Endoscopies showed a long, tight stricture in proximal to distal oesophagus stretched by Endoscopic dilatation many times. After 10 months of dealing with a recalcitrant stricture and weight loss, Mckeown Oesophagectomy was performed. Patient had an uneventful recovery. Histology showed chronic inflammation and fibrosis only and no tumour.
Alkaline ingestion can cause serious damage to Oesophageal and Gastric lining. Endoscopic management including Dilatation maybe trialled early on, but recalcitrant strictures require a surgical approach and sometimes, the stomach is not a viable option for a conduit and Transverse Colon has to be used.
Oesophagectomy, with or without associated Gastrectomy, may be required in strictures not amenable to repetitive endoscopic dilatation.