XCIV A Study of the Management of Caustic Esophageal Trauma

Abstract

The comphcations of caustic esophageal trauma are: death, esophageal stricture, perforation, major surgery, and hfelong disabil ity. Reviews have shown that, in the past, stricture could be expected in from 40 to 80 per cent of those with esophageal burns.** Today, with modern therapy, the stricture rate can be reduced to from 3 to 5 per cent.* The purpose of this paper is to describe a form of treat ment which is effective to this end.Over a two year period, seventy patients were admitted to the University of Rochester Medical Center with a history of caustic ingestion. These unselected patients were treated in the following manner:First: an airway was assured, neutralizing substances were ad ministered, and a thorough history and physical examination carried out. The status of the upper alimentary tract was especially noted.Second: a therapeutic program consisting of administration of methylprednisolone sodium succinate in doses of 20 to 40 mgm ini tially and twice a day, antibiotic coverage, and esophagoscopy was undertaken. Penicillin or tetracycUne were administered concur rently.Third: if esophagoscopy showed no burns, the patient was dis charged. If burns were noted, but did not penetrate the mucosa.

Management of severe lye corrosions of the oesophagus

“…In the presented material 76 per cent of the lye corrosions were the consequence of a suicidal attempt ._Lye had in most cases been ingested in olid form and in a large amount, accordingly most of the corrosions were very severe and of the 'full-thickness type' (Yarington et al, 1964). The effect of the swallowed lye is usually exerted on the lips, tongue and pharynx as well as on the oesophagus.…”

“…The effect of the swallowed lye is usually exerted on the lips, tongue and pharynx as well as on the oesophagus. Oesophageal corrosions may, however, occur without oropharyngeal burns; this was the case in more than 15 per cent of the patients reported by Yarington et al (1964). On the other hand a considerable number of patients who have ingested a corrosive have no lesions in the oesophagus, although the mouth and pharynx are involved; this was the case in 44 per cent in a series reported by Palva (i960) and in 25 per cent in the series reported by Yarington et al (1964).…”

“…Oesophageal corrosions may, however, occur without oropharyngeal burns; this was the case in more than 15 per cent of the patients reported by Yarington et al (1964). On the other hand a considerable number of patients who have ingested a corrosive have no lesions in the oesophagus, although the mouth and pharynx are involved; this was the case in 44 per cent in a series reported by Palva (i960) and in 25 per cent in the series reported by Yarington et al (1964). Almost all our patients had severe corrosions in the oral cavity and the oesophagus as well; some of the patients had, however, wrapped the solid lye in some kind of vegetable leaf before swallowing it to conceal the suicidal attempt, and accordingly there was a severe corrosion in the oesophagus without visible burns in the oral cavity.…”

Antidotes in Depth | Pavia, 2012-2017

“…Compulsive hot bathing had a serious impact in almost half of these patients. Several patient received a psychiatric diagnosis for the abnormal behavior (7) or along the extenuating course of the condition (13). Despite the large number of treatment used, the only definitive therapy appeared to be cannabis use cessation.…”

“…Hyperchloremic metabolic acidosis and hypernatriemia has been described in four adult deliberate ingestion and seem related with high-grade gastricesophageal lesions and poor prognosis (1 fatal case with gastric perforation, 1 gastric perforation, 1 esophageal perforation and 1 with esophageal lesions and hemodynamic disorders) 8,[10][11][12] . Concerning accidental exposure, about 40% of adult patient that ingested 1-2 swallows of 5-10% hypochlorite solution presented moderate gastric-esophageal lesions 13,14 . Pediatric case series showed that one accidental swallow of 4-10% hypochlorite at 10-11 pH solution may be associated with moderate gastric (5% of patients) or esophageal lesions (30% of patients) 15,16 .…”