Pneumomediastinum complicating accidental ingestion of HCl: A case study

 Corresponding author: A. Mourhri Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Pneumomediastinum complicating accidental ingestion of HCl: A case study A. Mourhri *, M. Ijim, S. Moatassime, O. Fikri and L. Amro Department of Pulmonology, ARRAZI Hospital, Mohammed VI University Hospital Center, FMPM, LRMS Labo, UCA, Marrakech, Morocco. World Journal of Advanced Research and Reviews, 2025, 28(02), 2582-2585 Publication history: Received 15 October 2025; revised on 26 November 2025; accepted on 29 November 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.28.2.3969 Abstract Accidental ingestion of hydrochloric acid (HCl) is a medical emergency associated with significant morbidity due to its corrosive effects on the upper digestive tract. Pneumomediastinum, although rare, is one of its potentially severe complications. It is defined as the presence of air within the mediastinum and typically results from esophageal or gastric perforation caused by caustic injury. Clinical manifestations may include chest pain, dyspnea, dysphagia, and subcutaneous emphysema. Diagnosis relies on imaging, with computed tomography (CT) being the most sensitive modality. Management requires urgent multidisciplinary care, including stabilization, early endoscopic assessment, broad-spectrum antibiotics, and surgical intervention when perforation is identified. Prognosis is largely dependent on early diagnosis and timely therapeutic intervention. We report a rare case of pneumomediastinum complicating accidental HCl ingestion. Keywords: Pneumomediastinum; HCl; Ingestion; Tracheal Perforation; Esophagitis; Subcutaneous Emphysema 1. Introduction Accidental ingestion of hydrochloric acid (HCl) represents a rare but potentially life-threatening medical emergency. This chemical, widely used in domestic and industrial settings, can cause extensive upper digestive tract injury, ranging from superficial burns to full-thickness necrosis and perforation. Among the most serious complications associated with caustic ingestion is pneumomediastinum, which occurs when air leaks into the mediastinal space, most commonly secondary to esophageal perforation. Although uncommon, pneumomediastinum significantly increases morbidity and can rapidly lead to mediastinitis or septic shock. Early clinical recognition combined with appropriate radiological assessment is essential for guiding management. This report describes a case of pneumomediastinum following accidental HCl ingestion and discusses its clinical presentation, pathophysiology, diagnostic approach, and management. 2. Patient and Observation This is an 18-year-old patient, originally from and residing in Marrakech, a high school student with no significant past medical history, he presented – following the accidental ingestion of a caustic substance: HCL – the progressive onset of aphagia, retrosternal chest pain, productive cough with whitish sputum, and a notion of an episode of moderate hematemesis, all evolving in an apyretic context and with a deterioration in general condition: asthenia, anorexia, weight loss (14kg in 1 month). General examination: Subcutaneous emphysema at the supraclavicular and bilateral cervical levels. Pleuropulmonary examination: unremarkable . Chest X-ray was performed: hyper lucency along the cardiac contours On the biological level, the NFS had shown laboratery findings leukocytosis with a predominance of neutrophils: WBC: 12430, neutrophils: 11280, without lymphopenia or anemia: Lym: 1549 Hb: 15.6, an increase in CRP World Journal of Advanced Research and Reviews, 2025, 28(02), 2582-2585 2583 to 94.28 was noted, the rest of the hepatic, renal, and electrolyte tests were without anomalies. CT : Subcutaneous emphysema in the supraclavicular and cervical regions, extending to the deep spaces of the face, at the level of the anterior thoracic wall, intramedullary, and posterior perivertebral regions. Mediastinal pneumothorax of moderate abundance, identification of a posterior wall defect of the trachea at the level of D4 measuring 1mm. Oeso-gastroduodenal endoscopy on day 1: Esophagitis classified as stage IIIb + gastritis classified as stage Ia Esophagogastroduodenoscopy on Day 21: Unpassable esophageal stricture Exploratory bronchoscopy of the bronchial tree: Normal endoscopic appearance of the trachea; no visible fistula, fine carina, and at the level of the right and left bronchi: Appearance without particularities, no necrosis, no visible fistula, fine spurs, free orifices, apart from a whitish secretion, an aspiration for cytobacterial study was performed: returned sterile. Figure 1 Hyperlinear clarity along the cardiac contours Figure 2 Moderate pneumomediastinum The diagnosis of pneumomediastinum secondary to HCl ingestion was confirmed. The patient underwent resection of the oesophageal stricture with digestive and tracheal reconstruction, antibiotic therapy, and enteral feeding via a gastrotomy tube. Clincal parameters, including oxygen saturation, heart rate, respiratory rate and blood pressure, were closely monitored. 3. Discussion Mediastinal emphysema is a rare but serious medical emergency that can result from the ingestion of caustic substances, such as hydrochloric acid (HCl) [1]. This condition primarily occurs due to the perforation of the esophagus or stomach, allowing air to spread into the mediastinum. During the ingestion of HCl, tissue necrosis caused by the acid can lead to deep mucosal lesions that, if not treated promptly, can progress to perforations [2]. Once these perforations occur, the air contained in the respiratory tract can migrate to the mediastinum, resulting in pneumomediastinum [3]. The ingestion of HCl causes a chemical burn of the tissues, with destruction of the esophageal mucosa and sometimes the gastric wall [4]. If these lesions lead to perforation, air can escape into the mediastinal cavity, which is observed in about 1 to 3% of cases of caustic ingestion [2]. Patients exhibiting symptoms of pneumomediastinum after ingestion of caustic acids, particularly HCl, may suffer from acute chest pain, hypotension, and dyspnea [2]. In some cases, subcutaneous emphysema is also noted [3]. World Journal of Advanced Research and Reviews, 2025, 28(02), 2582-2585 2584 The diagnosis of pneumomediastinum is often made using chest X-rays and computed tomography (CT). X-rays can show a radiolucent space in the mediastinal region, while CT scans are more sensitive for detecting small amounts of air in the mediastinum and can identify complications such as fluid collections, mediastinitis, or the presence of gas in the tissues [3]. CT scans also allow for the assessment of the extent of the lesions and guide therapeutic management [4,5]. Endoscopy: Performed cautiously, it allows for the visualization of caustic lesions and the assessment of perforation risk [4]. Management is based on initial stabilization: Immediate measures include hydration, airway management if necessary, and strict fasting to limit digestive stress [5]. Antibiotic therapy: Early antibiotic coverage is recommended to prevent secondary mediastinitis [5].Surgical intervention: In cases of massive perforation, surgery may be necessary to repair the lesions and drain the mediastinum [6]. Nutritional support: Parenteral or enteral nutrition via a post-pyloric tube is essential to prevent malnutrition [6]. The prognosis for patients with pneumomediastinum secondary to HCl ingestion largely depends on the speed of diagnosis and management. Patients with esophageal perforation and pneumomediastinum require early treatment to avoid serious complications such as mediastinitis, mediastinal abscess, or septic shock [7]. Deaths can occur if treatment is delayed or inadequate, particularly in the present. Pneumomediastinum can progress to mediastinitis, a condition associated with a high mortality rate. Other complications include esophageal fistulas, mediastinal abscesses, and secondary esophageal strictures [8, 9]. 4. Conclusion Pneumomediastinum is a rare but potentially fatal complication of hydrochloric acid ingestion. Early recognition combined with rapid multidisciplinary management is crucial to improving patient outcomes. Surgical intervention, endoscopic management, and antibiotic follow-up are key elements of this care. Rigorous monitoring and appropriate treatment increase the chances of survival for these patients. Compliance with ethical standards Disclosure of Conflict of Interest The authors declare that they have no conflict of interest. Statement of Informed Consent Written informed consent was obtained from the patient. 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