S4618 A Case of Caustic Ingestion With Potassium Thiocyanate

Introduction: Caustic ingestions are a common cause for injuries to the upper gastrointestinal tract, most notable the esophagus and stomach. We report a case of caustic injury to the upper GI tract following ingestion of potassium thiocyanate, an occurrence which has not been previously reported. Case Description/Methods: A 48-year-old woman with a history of depression presented following ingestion of potassium thiocyanate approximately 2 hours prior to arrival. She had multiple episodes of hematemesis and hematochezia. On exam, she was lethargic with evidence of perioral dried blood, hyperactive bowel sounds, and dark red blood on rectal exam. Labs showed leukocytosis, anemia, hyperkalemia, and worsening acidosis. Computed tomography findings demonstrated mild esophageal wall thickening and edema, severe diffuse wall thickening of the stomach, duodenum, and majority of the jejunum with fat stranding and edema. The patient was started on intravenous proton pump inhibitor twice daily. Esophagogastroduodenoscopy showed Zargar Caustic Ingestion Injury Grade 1 in the proximal esophagus, Grade 2a at the distal 3 cm of the esophagus, and Grade 3a gastritis with diffuse severe mucosal changes with areas of black discoloration and ulceration along entire stomach from both the greater and lesser curvature to antrum/prepyloric region. Due to concern for extensive and transmural necrosis of the stomach, the patient underwent immediate exploratory laparotomy revealing a thickened but nonthreatened stomach with an ulcer visualized at the gastroesophageal junction on the posterior stomach, threatened 1 cm D2 segment of the duodenum, and thickened and scattered petechiae of the first 60 cm of the jejunum without evidence of overt necrosis. The colon was healthy appearing. The abdomen was left open and the patient returned to the operating room after 48 hours for abdominal washout and closure. At the time, no further progression of ischemia or necrosis of bowel was noted. On day 18, the patient underwent an esophagram, showing no esophageal leakage and mild delayed contrast transit to the stomach and mild distal esophagitis, gastritis, and duodenitis. The nasogastric tube was removed on day 19, and the patient subsequently tolerated an oral diet and was discharged on day 24. Discussion: We present the first case of caustic injury to the upper gastrointestinal tract following ingestion of potassium thiocyanate. Our case emphasizes the importance of immediate endoscopic evaluation to determine the severity of tissue injury in order to determine treatment options and predict prognosis.