S4599 Extensive Corrosive Necrosis of Gastrointestinal Tract Following Herbal Therapy

Introduction: Traditionally, herbal medicines are used to treat diseases or maintain health, often considered safe. Corrosive injuries caused by this alternative medicine ingestion are an emerging health concern and reported scarce. We present a case of severe corrosive necrosis of esophagus and stomach in an elderly man following herbal medicine consumption. Case Description/Methods: A man in seventies with a history of chronic headache was brought to our emergency room with 3-day history of low-grade fever, abdominal discomfort, and odynophagia. His physical examination and lab tests were unremarkable. Contrast-enhanced computed tomography (CECT) demonstrated non-visualization of the esophagus suggestive of an esophageal mass. The patient’s family reported patient’s recent use of herbal products for headaches. Based on the history suspected chemical injury and an urgent esophagogastroduodenoscopy revealed extensive necrosis of the esophagus, stomach, and duodenum with darkish grey fluid in the gastric lumen. The patient received N-acetylcysteine (NAC) infusion, micronutrient supplementation, total parenteral nutrition, and feeding jejunostomy during his hospital course. Despite supportive care, he developed esophageal strictures and underwent multiple sessions of endoscopic dilation. Discussion: Corrosive ingestion due to alternative medicine could result in catastrophic outcomes. Esophagoduodenoscopy remains a crucial tool in the early assessment and prognostication of mucosal injury. Zangar classification is widely used endoscopic grading system and grades 2B-4 has worse prognosis. Early administration of NAC with vitamin B complex shown faster recovery and reduced long-term complications. A thorough history, timely endoscopic evaluation, and early intervention are pivotal in optimizing patient outcomes. This case highlights the occurrence of corrosive injuries due to herbal medicine, the need for heightened awareness among clinicians and establishment of standardized protocols in managing the serious complications of herbal remedies.