Treatment of distinctive liquefactive necrosis of the larynx after lye ingestion in suicidal intention

A 16 year old girl swallowed drain cleaner (rorax®) in suicidal intention. After emergency treatment and intubation the necrotic esophagus and stomach had to be removed. A pharyngeal stoma as well as a witzel-fistula to the duodenum was placed. The extensive affection of the pharyngeal and laryngeal mucosa caused a liquefactive necrosis and to a closure of the pharyngeal fistula. Due to ongoing scarifications, 4 weeks after the impairment an emergency coniotomy, followed by a tracheostomy had to be performed.

The supraglottic larynx and hypopharynx had to be reopened via lasersurgical intervention several times, combined with a local treatment with mitomycin C. The scarring tended to dissolve the anatomic structures. The reopening allowed voice production and the urgent needed treatment by a child and adolescent psychiatrist.

Currently the patient is under control in our department. She is currently able to speak clearly with a fenestrated tracheal canula and a passy muir valve. A reconstruction of the stomach and esophagus is currently not possible because of the ongoing tendency of scarification.

The liquefactive necrosis of the larynx caused by lye ingestion is challenging for the laryngologist and leads so a far-reaching scarification which is very difficult to treat. The local mid- to long term effects of lye require frequent checkups and interventions to preserve voice production and provide an acceptable situation for further reconstruction approaches.

Poster-PDF A-1819.PDF

Publication History

Article published online:
10 June 2020