Caustic substance injuries

Wasserman, Richard L.; Ginsburg, Charles M.

doi:10.1016/s0022-3476(85)80119-0

Cited by 66 publications

(49 citation statements)

References 15 publications

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“…In a retrospective study over a period of 31 years (195c1980) 560 children were admitted with a history of corrosive substance ingestion and 99% were less than 5 years old [2]. Oesophageal stricture is the most frequent and significant long-term complication [3]. The majority of strictures can be treated effectively by repeated dilatation and surgery is recommended only when the repeated dilatation fails to achieve adequate symptomatic relief.…”

Section: Discussionmentioning

confidence: 99%

A rare and fatal complication of oesophagoscopy

1994

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SummaryA 3.5-year-old child developed a tight oesophageal stricture following ingestion of caustic soda. At the end of the fourth anaesthetic for oesophageal dilatation, laryngospasm and dificulty in mask ventilation was followed by cyanosis, bradycardia, and cardiac arrest. Chest X ray showed a large pneumopericardium, which was immediately aspirated, but unfortunately resuscitation was unsuccessful. It was presumed that during attempted manual ventilation of the lungs in the presence of a closed glottis, air had been accidentally forced into the pericardium through a small tear in the fragile oesophagus. Key wordsComplications; pneumopericardium, death. Gastrointestinal tract; oesophagus. Surgery ; oesophagoscopy.In children, oesophagoscopy is usually performed to dilate a stricture or to remove a foreign body. Perforation of the oesophagus, pneumomediastinum, mediastinitis, pneumothorax and surgical emphysema are some of the complications of this technique. We report the development of tension pneumopericardium in a child following oesophagoscopy under general anaesthesia.Case history A 3.5-year-old boy was brought to the emergency room with a history of ingestion of caustic soda (sodium hydroxide granules) which is extensively used as drain opener in Saudi Arabia. Clinical examination showed evidence of chemical burns in the oral cavity and marked oedema of the soft palate, with ulceration of the posterior pharyngeal wall. The rest of the systemic and biochemical examination was normal. X ray of the chest was also normal. The child was treated conservatively with intravenous fluids, antibiotics and hydrocortisone and was discharged after 4 days in hospital.Four weeks later the child was re-admitted with recurrent vomiting and refusing to eat or drink. On examination, he was markedly dehydrated and malnourished and there was dribbling of saliva which he was unable to swallow. Systemic examination and chest X ray was essentially normal. Barium swallow and examination showed extensive mucosal ulceration, oedema and narrowing of the lumen of the oesophagus. The pylorus was the size of a pin hole and the child underwent a pyloroplasty. During the subsequent visit upper gastro-intestinal endoscopy was performed under general anaesthesia. A tight stricture of 7-8 cm in length was noted, which started at 7cm from the central incisor and finished 2 cm from the oesophagogastric junction. The stricture was dilated gradually up to 1 1 mm (5, 7,9, 11 mm) using the Savory Gillard dilators and re-endoscopy confirmed adequate dilation. The child underwent three dilations under general anaesthesia at 2-3 week intervals without any complications.Twelve weeks after the initial admission the child was again brought to the hospital with increasing dysphagia, even to semi-solid food and fluids. A pre-operative assessment was done by a consultant anaesthetist. The family was informed about the possible complications and consent was obtained. He was a child of average height and body build (body weight 15 kg). He had no cough or na...

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Section: Discussionmentioning

confidence: 99%

A rare and fatal complication of oesophagoscopy

1994

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“…In 1985, Wasserman reported that approximately 5000 children younger than 5 years ingested lye each year in the United States [2]; in 2008, the USA National Poison Data reported over 200,000 exposures to caustic substances [3]. Unfortunately, the true prevalence regarding this health problem is not known in most developing countries and cannot be extrapolated from publications of series of children with CI treated in paediatric hospitals; however, these publications describe demographic, clinical and treatment characteristics of children from low, lower-middle and high-income countries information is scarce specially in lower-middle income countries [1].…”

Section: Epidemiologymentioning

confidence: 99%

“…The physical form, concentration, and pH of the corrosive agent play a signiicant role in the location and type of resultant injuries [2]. Acid substances lead to coagulation necrosis that usually limits acid penetration and results in damage to the epithelium and submucosal layer.…”

Section: Physiopathologymentioning

confidence: 99%

Caustic Ingestion in Children

Larrosa‐Haro¹,

Sánchez-Ramírez²,

MMesa-Magaña³

et al. 2017

Esophageal Abnormalities

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Caustic ingestion (CI) is an unfortunate event that occurs in families with a poor prevention culture. Its prevalence is unknown in developing countries; it occurs mainly in children < 5 years and is more common in boys. The chemical caustic agents are alkaline (85%) or acid products stored in food or beverage containers without warning labels and safety caps. The immediate symptoms include salivation, oropharyngeal burns, vomiting and oropharyngeal/retrosternal pain. Upper endoscopy is the irst-line tool to identify the type and extension of oesophageal and gastric damage. A barium swallow performed 2-3 weeks after the CI may identify oesophageal stricture. Dysphagia occurs in about one-third of cases. Regarding the nutritional status, children with dysphagia and/or oesophageal strictures may have lower fat reserves or muscle mass than the cases without these complications, meaning impaired nutritional status. All patients should be hospitalized for evaluation and treatment. Hemodynamic stabilization and adequacy of the patient's airway are priorities; vomiting induction and gastric lavage are contraindicated. Methylprednisolone in II-b oesophageal burns for 3 days diminishes the risk of stricture. Selected cases will require oesophageal dilatations, gastrostomy or oesophageal replacement by colon or stomach. There are other promising agents in the management of caustic oesophageal strictures.

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“…The severity of damage depends on corrosive properties, amount, concentration, physical form and duration of contact with the mucosa [3,4]. In terms of severity evaluation, symptoms and signs alone are unreliable [5].…”

Section: Introductionmentioning

confidence: 99%

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

Puo-Hsien¹,

Seak²,

Chiu³

et al. 2017

J Gastrointest Dig Syst

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Severe caustic ingestion often leads to multiple complications and high mortality rate. Esophagogastroduodenoscopy is recommended during the first 24 hours for severity and extent evaluation, but it seems insufficient to guide further managements in severe caustic injury patients due to rapid progression and variable clinical conditions. Therefore, we tried to evaluate the safety and role of second-look endoscopy in these patients in 1-2 weeks later.We retrospectively collected severe esophageal caustic injury (grade 2b, 3a, 3b) adults with and without secondlook endoscopy in subacute stage (6 th -14 th days after caustic injury) in Linkou Change Gung Memorial Hospital during 2011/1-2014/11. They were divided in to once endoscopy group and second-look endoscopic group according to the patients with second-look endoscopy or not. They were further matched with the same cause of caustic injury, corrosive properties, injury grading, and then selected with Excel RAND function. There were 26 patients in both groups.The average timing of second-look endoscopy was 10.23 ± 3.166 (mean ± SD) days after caustic ingestion. The hospital stay was significantly shorter in the second-look endoscopy group (24.92 ± 17.50 days, 54.38 ± 43.73 days, P=0.002). However, the complication rate was not statistically significant between these two groups.In conclusion, second-look endoscopy is safe and might shorten the hospital stay. However, prospective, randomized and larger sample size studies are needed to support the finding.

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Caustic substance injuries

Cited by 66 publications

References 15 publications

A rare and fatal complication of oesophagoscopy

A rare and fatal complication of oesophagoscopy

Caustic Ingestion in Children

The Role of Second-look Endoscopy in Severe Esophageal Caustic Injury

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