A 46-year-old woman was admitted 3 hours after she had ingested about 500ml of a toilet bowl cleaner (included 9.5% hydrochloric acid) in attempt to commit suicide. On admission, the base excess in the arterial blood was-20mEq/l and she had hypotension and anuria. An endoscopic examination on admission revealed corrosive degeneration in the entire esophagus and stomach. Abdominal compartment syndrome developed on the 5th hospital day and a decompression laparotomy was performed, which revealed necrosis of the whole stomach. A total gastrectomy without reconstruction was performed. On the 18th day, air leakage into oral cavity was seen during the inspiratory phase of the artificial ventilation. A bronchial fiberscope revealed an ulcer in the posterior wall of the left main bronchus. The air leakage stopped after the placement of a bronchial stent. However, the patient died on the 33rd day due to uncontrollable bronchial bleeding. Autopsy revealed severe mediastinal necrosis, esophago-bronchial fistula, and azygos vein destruction at the arch. According to our case and literature reviews of acid toilet bowel cleaner ingestion, most patients who died of esophageal perforation or esophago-bronchial (or tracheal) fistula had the following characters: ingested a volume of>300ml, severe acidemia, severe corrosive degeneration in the entire esophageal and gastric mucosa. In the patients who demonstrated such characters, an early esophagectomy is therefore recommended as a possible option to improve their outcomes.
