Total Gastrectomy after Sodium-Silicate Ingestion: Early Surgical Treatment for Alkali Injury: A Case Report

Kim, Si Young; Lee, Kug Jong; Jung, Yong Sik; Min, Young Gi; Cho, Joon Pil

Abstract

Sodium silicate is generally used for laundering and dishwashing and for anti-fire and anti-water agents. Liquid forms of sodium silicate (water, glass) have extremely high pH values that the range from 12.5 to 13. Thus, ingestion of this material causes various caustic injuries to the digestive tract. Management of alkali ingestion includes decontamination, dilution, and surgical treatment. A widely performed surgical treatments for these cases are emergency laparotomies for repair of perforations and palliative care for stricture or obstruction of the injured hollow viscus organs. Recently, early and extensive surgical management based on an endoscopic evaluation was introduced for severe alkali injuries. Endoscopy is not only a safe and reliable tool for diagnosis but also is important in the treatment of and the prognosis for alkali ingestion. We report the case of a 48-year-old man presenting to the emergency department with an intentional ingestion of an anti-water agent for cement work. That agent contained sodium silicate. Fiberoptic endoscopy of the upper digestive tract showed severe alkali burns in the stomach, including edema, hemorrhage and necrosis. Surgery was performed to remove the necrotic tissue and to prevent progression to a critical status. We carried out a total gastrectomy, Roux-Y anastomosis, segmental resection of proximal jejunum and a feeding jejunostomy. After the operation, there were no complications associated with either the surgery or the caustic injury. The patient was discharged in good general condition with oral feeding status. In conclusion, for severe alkali ingstion, we recommend early surgical resection of injured organs identified by using an endoscopic evaluation.