Extensive Esophageal and Gastro-Duodenal Necrosis Following Caustic Ingestion in an Adolescent: A Case Report

Introduction While caustic injuries to the esophagus and stomach are well documented, total necrosis of the upper gastrointestinal tract is exceedingly rare. Case presentation We report the case of a 16-year-old female who presented with acute abdominal symptoms initially misdiagnosed as gastritis, later found to have catastrophic gastrointestinal injury following suspected ingestion of a hydrochloric acid-containing cleaning agent. Imaging and endoscopic evaluation revealed extensive full-thickness necrosis involving the esophagus, stomach, and duodenum, complicated by perforation and generalized peritonitis. The patient underwent emergency damage-control surgery, including total esophagectomy, total gastrectomy, and duodenal resection with preservation of the pancreatic head, followed by reconstruction with jejunal feeding access and drainage procedures. Her postoperative course was complicated by a pancreatic leak, which was managed conservatively. She was discharged after 20 days with psychiatric support and remained clinically stable at 2-year follow-up, although definitive gastrointestinal reconstruction was not feasible due to severe residual stenosis. Conclusion In catastrophic caustic injuries with extensive upper gastrointestinal necrosis, preservation and reimplantation of a viable ampullary remnant may provide a feasible alternative to pancreatoduodenectomy during emergency damage-control surgery.