Surgical Solution to Lye Ingestion Wounds

It was 2 a.m. one Saturday in November when nine young people at a party in a Conover, N.C., home came upon a wine bottle in a refrigerator. As Wayne Meredith, MD, recalled, the first person took a deep swig from the bottle and ran from the room. The second person to take the bottle and drink deeply was mute and couldn’t communicate that something was wrong with the “wine.’’ It wasn’t until the third person drank that the revelers began to recognize a problem. Even so, others also sipped from the “wine.”

As it turned out, the liquid in the bottle was liquid lye, which was in the refrigerator for baking purposes; diluted potassium hydroxide is frequently brushed onto baked products such as pretzels.

In this case, however, the corrosive lye would eat its way through some of the victims’ stomachs and throats, and caused severe burns of their mouths and tongues.

The young people were all originally taken to Catawba Memorial Hospital in Hickory, but were soon transported to N.C. Baptist Hospital, where Meredith, then a thoracic surgery resident, became part of the team that would have to devise a solution to the multiple severe stomach and throat wounds.

Leading the team was Meredith’s father, Jesse Meredith, MD, and soon to join was James N. Thompson, MD, an ear, nose and throat specialist.

Treating the Wounds

The team had to determine how to treat the victims, because there was little in medical journals and literature about liquid lye, and most of what had been written about similar injuries suggested treatment such as steroids.

“The first kid who drank it had a terrible injury; his stomach was eaten up, killed, dead, rotten. His mouth was totally burned. You couldn’t look in his esophagus with a scope, it was just black,” Meredith said.

“And so we operated on him because it seemed like he had an acute abdomen and sure enough he did; entire stomach was dead. His pancreas, which lives behind the stomach, was burned from the lye eating through the stomach. We didn’t take his pancreas out, but we cleaned off the dead tissue there and watched it. We took out his stomach, and I think we took out his esophagus at the same time.

“And we decided we needed to start operating on these kids. Line them up, worst to best, and start operating on them until we find one that’s OK. So we wound up operating on three of them that day.”

Others would face different kinds of surgeries to the stomachs and esophagi in the days to come, and all faced months and years of rehabilitation.

In a couple of cases, a piece of the victim’s colon was removed and brought up to the bottom of the pharynx to act as a conduit to the duodenum, in effect creating a new esophagus and stomach.

Although the most severe victim had permanent trouble with swallowing, all of the victims survived and were able to regain eating function despite their severe wounds. The doctors wrote about the case for the Journal of Trauma.

A Team of Volunteers

Wayne Meredith, who today is director of Surgical Sciences for Wake Forest Baptist, said the case resonates for reasons beyond the unique surgical aspects.

“Another thing that I remember so clearly about this is, I mean, this was a Saturday afternoon and Saturday evening. And people came, residents came, other doctors came, people came from everywhere who weren’t on call, who didn’t have to. But they knew we had need for more people and more help. And people just came.

“And a team formed of its own out of the goodness of people’s hearts and the desire to do the right thing. People would assign themselves to a patient, stick with a patient. They’d constantly make phone calls. They kept everybody in touch with everything that was going on. It was really my first exposure that I could remember to a mass-casualty event. Now it’s a very formal process, but it is almost exactly the process that happened by itself with this group of kids. So the outpouring of people’s altruism totally impressed me.

“And, of course, on a human note, it’s always cool to have an opportunity to be really proud of your father. He was just a superb clinician. He was a superb technical surgeon. He did all of this without breaking a sweat. He was never nervous. He was never frustrated, overwhelmed, any of that. He was just trying to keep these kids from suffering, trying to help them as much as he could.”

Wayne Meredith has handled “tons” of unique situations in the years since the multiple stomach and esophagi replacement surgeries involved in the lye ingestion case. He noted an unusual right heart rupture and two cases of lion bites, among others. It’s part of the joy, he said, of doing general surgery and trauma.

“It’s one of the things I like about trauma as a career,” he said. “I like having a job where I see stuff I’ve never seen before.”