Gastrointestinal complications in burns

Complications involving the gastrointestinal tract are commonly seen in thermal injuries and are present in a variety of forms. To date, 322 complications have been documented in 1,291 cases, an over-all incidence of 24.9 per cent. The paralytic ileus frequently accompanying burns requires nasogastric intubation. Esophageal stricture and erosion can result unless tubes are removed as soon as possible. Curling's ulceration of the stomach and duodenum is the most prevalent problem and is related to the magnitude of the burn and to a decrease in mucus production by the stomach. Ordinary therapeutic measures commonly used in the treatment of peptic ulcer have not been effective. Perforation and severe hemorrhage require hemigastrectomy and vagotomy; lesser procedures have not been effective. Nine cases of acute cholecystitis, seven occurring without the presence of calculi, have been seen. Cholecytectomy is the treatment of choice. Several cases of hemorrhagic pancreatitis have occurred, and at autopsy subclinical pancreatitis is a frequent finding. Nonoperative treatment is recommended. Four cases of severe weight loss with duodenal obstruction by the superior mesenteric artery have been successfully managed by duodenojejunostomy. Involvement of the small and large intestine has been recorded in thirty-three instances and usually represents sequelae of low flow states or sepsis associated with thermal injury. Conventional treatment is effective. The presence of a burn makes diagnosis more difficult, thereby delaying treatment. Thus, a keen awareness of the potential hazard of gastrointestinal complications after thermal injury is the key to successful management.