Evaluation of 968 children with corrosive substance ingestion

Abstract

Background and Aims:The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature.Materials and Methods:The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used.Results:A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1–52 sessions (mean 15 ±12) of dilatation.Conclusion:We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.

Corrosive Substance Ingestion in Children: A Current Evaluation and Treatment Approach

“…[5][6][7][8][9][10]47 Buna rağmen geleneksel olarak hastaların 3 hafta sonra özofagografi için polikliniğe çağırılması dikkat çekicidir. 2,13,25,[47][48][49] Türkiye'de yapılmış bir klinik çalışmada, korozif madde içimi sonrası özofagus darlığı gelişen hastaların dilatasyona başlama zamanına göre erken tedavi (10-14. gün) ve geç tedavi (≥21 gün) grupları karşılaştırılmış ve erken tedavi grubunda anlamlı derecede yüz güldürücü sonuçlar [ortalama dilatasyon sayısı/tedavi süresi; erken tedavi grubunda yaklaşık 6 seans/4 ay, geç tedavi grubunda ise 17 seans/14 ay, her ikisi için de p<0,001] bulunmuştur. 6 Sonuç olarak; endoskopik derecelendirme, hastanın aç bırakılması ve baryum grafisine dayanan alışılagelmiş yaklaşım artık terk edilmeli ve özofagus darlığı 10-14. günler arasında yutma güçlüğü olan her hastada yapılacak olan endoskopiyle erkenden tanınmalı ve hemen aynı anestezi altında dilate edilerek tedavi süreci başlatılmalıdır.…”

Caustic accidents in childhood - a proposal for care in the acute and chronic phases of the accident

“…Entretanto, a conduta e tratamento ainda são controversos, além de apresentarem internações de alto custo, alta morbidade e cuidados multidisciplinares a longo prazo. 1,3,4…”

Prevention of ingestion injuries in children

“…[17,18] Injury depends on the chemical concentration and volume, the tissue surface area and the duration of exposure. Among the most common serious long-term sequelae is oesophageal stricture formation (7 -25%), [12,17] which occurs when submucosal penetration of the burn involves >50% of the lumen.…”

“…These are therefore not a major risk factor for oesophageal strictures; nevertheless, they result in a significant number of visits to emergency departments although more than symptomatic treatment is usually not required. [12] More concentrated agents used in industrial or agricultural contexts may be ingested, particularly in rural areas. [11] …”

“…[11] Male gender predominance is an inconstant finding. [5,9,[12][13][14] Curiosity, exploration of the developing oral phase, the child's inexperience and limited understanding of the environment combined with inadequate caregiver supervision put children under-5 [15] at the highest risk of injury from ingested foreign bodies and caustic substances, with a peak incidence at 3 years of age. [5] A child may present acutely with peri-oral inflammation, dysphagia, drooling, cough, stridor, hoarseness, vomiting or signs of peritonitis.…”