Diagnostic and Therapeutic Management of Esophageal and Gastric Caustic Burns in Childhood

Abstract

Early esophago-gastroscopy is the most effective investigation for the classification of caustic burns. Evaluation includes graduation of the pathological lesion. Assessment of extension of spread and of control of motility of esophagus and stomach. The aim of all therapeutic procedures is to preserve the patients' own esophagus. All endoscopies were done under general anesthesia. From September 1988 to April 1992, 102 endoscopies were carried out on 39 patients. Gastric lesions with clinical relevance were found in 10 patients (26%). First degree of corrosion was found in 21 patients (54%): they were discharged without any therapy within 48 hours. Maximal second degree was seen in 14 patients (36%), who were successfully treated with diet, antacids and H2-blockers: they were discharged after control-endoscopy after one week. Four patients (10%) suffered from third-grade lesions: a gastrostomy was performed as well as treatment with cortisone, antibiotics and H2-blockers. Bouginage was started between the 5th and 7th day after ingestion and was necessary for 8, 11 and 16 weeks in three patients and more than 2 years in one patient. Even in this last case we could preserve the esophagus, although a gastric or colon interposition was discussed.

Corrosive Burns of the Upper Gastrointestinal Tract among Jordanian Children

“…In our patients, 75.93% had normal endoscopy, and 4.17% with grade 1 were also eligible for early diagnosis, since none of these patients developed stricture on follow-up. This is in agreement with Rappert et al 9 In contrast to visible mouth and facial injury, which did not correspond to the internal finding of excessive salivation, refusal to eat always corresponds to esophageal injury, as we found in 30 (30.3%) of our patients. Three of our nine patients were cases of acid ingestion, involving concentrated vinegar and H 2 SO 4 (hydrogen sulfate), producing esophageal ulcers and only one patient with gastric ulcer, in contrast to what was reported by Chong et al, 10 where acid ingestion was more injurious to the stomach than the esophagus.…”

Corrosive injury of the oesophagus in children

“…Awareness of the dangers has increased amongst both the lay-public and professional groups, and this has had a positive impact on lowering the incidence and delays to treatment. Incidence of children with corrosive injury in the Czech Republic is much more higher when compared with other countries in EU and US [15,20]. As worldwide incidence did not increase, this implies that our findings are unique.…”

“…The incidence has increased in the past 5 years. A disquietingly larger number is seen in our country when comparing incidence of children with corrosive injury between the Czech Republic and other European countries [15] and the US, where this condition is relatively rare [20].…”

Colon interposition in a patient with total postcricoid stenosis after caustic ingestion and preservation of full laryngeal function

“…Our decision to delay surgery is also supported by Rappert et al [5], who advise initial conservative therapy in rehabilitation. We are convinced that it is best to start voice effort closure techniques preoperatively and to familiarize patients at the same time with supraglottic swallowing maneuvers.…”