Question

A 20-year-old female patient consumed a cleaning product containing 90% sodium hydroxide.She is having complete dysphagia. What is the best step in management?

• A. Esophagojejunostomy
• B. Stent placement
• C. Feeding jejunostomy
• D. Gastrojejunostomy

Answer 1

The Correct Option is C

The presented case involves a 20-year-old female with complete dysphagia after ingesting a cleaning product containing 90% sodium hydroxide. Sodium hydroxide is a strong alkali that can cause significant caustic injury to the esophagus, leading to complete obstruction or severe strictures.

Given the condition of complete dysphagia, the esophagus is likely severely compromised, and immediate esophageal use for feeding is not viable. Therefore, the management must focus on providing nutrition while bypassing the damaged esophagus.

The options include:

• Esophagojejunostomy: This involves connecting the jejunum to the esophagus. However, this is more appropriate for patients without complete esophageal obstruction and is a more invasive and definitive procedure not suited for immediate stabilization.
• Stent placement: Typically used for palliative management of esophageal strictures. However, with complete dysphagia from caustic ingestion, stent placement may not be feasible or effective initially.
• Feeding jejunostomy: This involves creating a feeding tube directly into the jejunum, allowing for immediate nutritional support while bypassing the esophagus.
• Gastrojejunostomy: While it connects the stomach to the jejunum, in cases of caustic ingestion, bypassing more of the upper GI tract may be necessary.

The most appropriate and immediate management step for providing adequate nutrition and bypassing the damaged esophagus in this scenario is a feeding jejunostomy.