Major ingestions of caustic agents may result in immediate perforation of the GI tract and require emergency surgery. The indications for emergency laparotomy include peritoneal signs or free intraperitoneal air. Esophageal perforation diagnosed by mediastinal air on plain films or by endoscopy is also an indication for emergent surgery. More controversial is the management of severe esophageal injuries, grade 2b and 3, without obvious perforation. Some authorities recommend early dilation therapy (in the first 3 weeks) with or without stenting, whereas others report good results with early surgical resection. 1819
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