Abstract
Even among non-trauma patients, damage control surgery has a wide application. We report on a case of gastrointestinal tract necrosis with disseminated intravascular coagulopathy (DIC) which occurred after the ingestion of a large amount of strong acid and which we treated with damage control surgery. A 70-year-old man was admitted after ingesting about 250ml of 35% hydrochloric acid. 7 hours after ingesting the acid, he exhibited hypotension and coagulopathy. Necrosis of entire stomach and duodenum were observed in an emergency exploratory laparotomy. Total gastrectomy and total pancreas-preserving duodenectomy without reconstruction were conducted. Because perioperative coagulopathy was sustained, vacuum pack closure was immediately performed with gauze packing to prevent retroperitoneal oozing. A second operation, including esophagectomy and pancreatico-choledochojejunostomy, was planned to be performed after coagulopathy had improved in the ICU, but the patient's family refused consent. Accordingly, only depacking and feeding jejunostomy were performed as palliative surgeries once his condition was good enough. The patient expired 28 days after admission due to mediastinitis from residual esophageal necrosis. Damage control surgery can be adequately applied in a non-trauma setting.
