Abstract
A 54-year-old woman attempted suicide by drinking 300 ml of undiluted alkaline bleach (Haiter®) and vomited once. When she arrived by ambulance to our hospital about one hour later, she had mild lactic acidosis, and a plain chest X-ray showed extensive pneumomediastinum. Computed tomography (CT) showed esophagitis-related wall thickening and pneumomediastinum. On endoscopy, necrotic perforation of the lower esophagus was seen near the esophagogastric junction. The diagnosis was corrosive esophagitis with acute perforation.
Although the perforation required closure, there was concern about causing further necrosis because the margins were indistinct. Therefore, fundoplication with fundal serosal patch repair of a large area including the perforation was performed. On day 27, esophagography showed no leakage or strictures, and on day 44, endoscopy confirmed mucosal repair and closure of the perforation.
Alkali-induced corrosive esophagitis with acute perforation, although relatively uncommon, is potentially life-threatening. Suture closure requiring debridement is difficult when the necrotic margins are indistinct. Fundal serosal patch repair can be useful in these cases.
