Gastrointestinal system lesions in children due to the ingestion of alkali andacid corrosive substances

Abstract

The ingestion of corrosive substances among children mostly occurs accidentally. Most of these corrosive agents are household cleaners, and the esophagus is the most damaged site of the gastrointestinal system. Perforation and death are potential serious complications in the acute period, while stricture and cancer can occur over chronic periods of time. Endoscopic inspection in the early hours after ingestion is very important for the evaluation of the lesions to allow the planning of the appropriate treatment and follow-up care of these patients (1-3).In this study, we investigated children who were admitted to our clinic due to corrosive substance ingestion or suspected ingestion and who subsequently underwent an upper gastrointestinal endoscopy. The aim of this study was to examine esophageal and gastric lesions in children due to the ingestion of alkaline and acidic corrosive substances and to emphasize all relevant complications. Materials and methodsOne hundred and three children who were admitted to our pediatric gastroenterology unit during a 3-year period complaining of corrosive substance ingestion and who subsequently received upper gastrointestinal endoscopies were enrolled in this study. Clinical and endoscopic findings, treatment regimes, and long-term complications were retrospectively evaluated.The endoscopic procedure was first performed with a 5-mm diameter flexible endoscopy device (Olympus Evis Lucera CLV-260SL) 12-24 h after the ingestion of the corrosive substance in the patients admitted to our clinic. Before the procedure, 0.1-0.4 mg/kg intravenous midazolam was administered to sedate the patients.Background/aim: To examine esophageal and gastric lesions in children due to the ingestion of alkali and acid corrosive substances and to emphasize all related complications. Materials and methods:The reports of 103 children who ingested or were suspected to have ingested corrosive substances and who then underwent upper gastrointestinal endoscopic inspections were evaluated retrospectively.Results: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%. Conclusion:Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently con...

The Prognostic Value of Some Initial Clinical Manifestations and Biochemical Parameters for Evaluating the Outcome in Corrosives Poisoned Children

“…Similar to the findings in the current study, vomiting was the most common symptom 44.7% in a study by Demirören et al (2015). Together with dysphagia, both were found to be strongly related to increased morbidity and mortality (Sagar et al, 2016).…”

Efficacy of Endoscopic Topical Mitomycin C Application in Caustic Esophageal Strictures in the Pediatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The age group that is subject to greater risk comprises children under the age of 5, since they already present autonomous capacity for mobility, but lack the cognitive capacity to recognize danger (22) . Each year, approximately 5,000 accidents with corrosive substances occur in children under the age of 5 in the United States (3) .…”

“…Ingestion of caustic products and the development of esophageal strictures are recognized major public health problems in childhood (1,2) . Esophageal perforation and mortality are potentially serious complications in the acute period, while strictures and cancer may occur in the chronic period (3,4) . Caustic strictures are considered the most challenging among esophageal strictures, with dilation as first-line treatment, aiming at preserving the native esophagus (5,6) .…”

Esophageal Diameters in Children Correlated to Body Weight

“…Likewise, stenoses are frequently consequences of acid or lye burn of the esophagus. 3 Balloon dilatation is currently first-line therapy of these stenosis. [4][5][6][7][8] Other possibilities encompass bouginage of the esophagus, 9 placement of stents, administration of cortisone or mitomycin or, 10 in severe cases, replacement of the esophagus with gastric pull up or interposition of large or small gut.…”