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Holtestaul T, Franko J, Escobar MA, Barlow M. Pediatric Ingestions. Surg Clin North Am 2022; 102:779-795. [DOI: 10.1016/j.suc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chen YJ, Seak CJ, Kang SC, Chen TH, Chen CC, Ng CJ, Lee CW, Su MY, Huang HC, Chen PC, Ooyang CH, Hsieh SY, Cheng HT. A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years. Clin Toxicol (Phila) 2020; 59:409-417. [PMID: 33078983 DOI: 10.1080/15563650.2020.1822998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose. METHODS The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar's modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22. RESULTS Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ≥ 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids. CONCLUSION Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. "Large doses of acids" and "high pH of alkalis" deserve special attention. This new perspective with a retrospective nature requires further validation.
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Affiliation(s)
- Yu-Jhou Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yao Su
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Board of Directors and Supervisors, Taiwan Association for the Study of Small intestinal Disease (TASSID), Taoyuan, Taiwan
| | - Hsin-Chih Huang
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Pin-Cheng Chen
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chun-Hsiang Ooyang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hao-Tsai Cheng
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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The comparison of prednisolone and honey activities in the experimental corrosive esophagitis model. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.674809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kang S, Kufta K, Sollecito TP, Panchal N. A treatment algorithm for the management of intraoral burns: A narrative review. Burns 2017; 44:1065-1076. [PMID: 29032979 DOI: 10.1016/j.burns.2017.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/25/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm. The algorithm was initially subdivided into the four primary etiologies of intraoral burns - thermogenic, cryogenic, chemical, electrical. Our findings emphasize the importance of conservative modalities of intra-oral burn treatment.
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Affiliation(s)
- Steve Kang
- University of Pennsylvania School of Dental Medicine, Robert Schattner Center, Oral Surgery Clinic, 240 S. 40th Street, Philadelphia, PA 19104, United States.
| | - Kenneth Kufta
- University of Pennsylvania School of Dental Medicine, Robert Schattner Center, Oral Surgery Clinic, 240 S. 40th Street, Philadelphia, PA 19104, United States; University of Pennsylvania Health System, Perelman Center for Advanced Medicine, South Pavilion, 4th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Thomas P Sollecito
- University of Pennsylvania School of Dental Medicine, Robert Schattner Center, Oral Surgery Clinic, 240 S. 40th Street, Philadelphia, PA 19104, United States; University of Pennsylvania Health System, Perelman Center for Advanced Medicine, South Pavilion, 4th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States.
| | - Neeraj Panchal
- University of Pennsylvania School of Dental Medicine, Robert Schattner Center, Oral Surgery Clinic, 240 S. 40th Street, Philadelphia, PA 19104, United States; University of Pennsylvania Health System, Perelman Center for Advanced Medicine, South Pavilion, 4th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Presbyterian Medical Center, 565 Wright Saunders, 51 N. 39th Street, Philadelphia, PA 19104, United States.
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Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg 2015; 10:48. [PMID: 26478740 PMCID: PMC4609064 DOI: 10.1186/s13017-015-0043-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.
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Shahi AS, Behdad B, Esmaeili A, Moztarzadeh M, Peyvandi H. Esophageal stenting in caustic injuries: a modified technique to avoid laparotomy. Gen Thorac Cardiovasc Surg 2015; 63:406-12. [PMID: 25971235 DOI: 10.1007/s11748-015-0558-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/01/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the outcomes of a modified laparoscopic intraluminal stenting with the conventional laparatomic technique in patients with esophageal caustic injuries. METHODS A total of 103 patients with esophageal burns were included in this retrospective analysis. Patients were candidates for esophageal stenting to prevent future stenosis. According to patient preference, stenting was done with either the innovatory stent with the modified technique (52 patients) or the conventional method that required laparotomy (51 patients). The modified technique consists of placing an inflation balloon stent via laparoscopy. Overall mortality and complications after follow-up period (3 months) were compared between the two groups. RESULTS Two perioperative mortalities were seen, one in each group. Except one patient in the modified technique, all patients returned to normal intake after 3 months of follow-up. However, five patients of the modified group and three in the conventional group developed esophageal strictures (p > 0.05). Gastric outlet obstruction was observed in three patients of the modified group and one in the conventional group (p > 0.05). DeMeester scores showed that there was no gastro-esophageal reflux in both groups (p > 0.05). CONCLUSION Our results show that the modified technique can reach the efficacy of the conventional method without requiring laparotomy. Thus, far several studies have demonstrated the advantages of laparoscopy over laparotomy. Thus, and in line with the clinical guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons, we recommend using the presented modified technique in patients with caustic esophageal injuries.
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Affiliation(s)
- Ali Sina Shahi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Saliakellis E, Borrelli O, Thapar N. Paediatric GI emergencies. Best Pract Res Clin Gastroenterol 2013; 27:799-817. [PMID: 24160935 DOI: 10.1016/j.bpg.2013.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/21/2013] [Indexed: 01/31/2023]
Abstract
Paediatric GI emergencies constitute a wide range of gut pathologies ranging from those that are common, easily diagnosed and treated to conditions that are rarer, often more severe and challenging to manage. Among a myriad of ordinary clinical symptoms and signs physicians have to identify the child with a serious, life-threatening pathology and initiate the appropriate diagnostic and therapeutic pathway. The aim of the review is to present and discuss a selection of key paediatric GI emergencies that provide challenges in diagnosis and treatment. These conditions are classified by their presentation or pathogenesis and include inflammatory conditions, those presenting with GI obstruction or haemorrhage and the ingestion of foreign bodies or caustic substances. The most recent advances regarding the management of these entities are discussed along with key areas of clinical practice and future research.
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Affiliation(s)
- Efstratios Saliakellis
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Okata Y, Hisamatsu C, Nishijima E, Okita Y. Topical application of basic fibroblast growth factor reduces esophageal stricture and esophageal neural damage after sodium hydroxide-induced esophagitis in rats. Pediatr Surg Int 2012; 28:43-9. [PMID: 22009209 DOI: 10.1007/s00383-011-3007-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the effect of topical application of basic fibroblast growth factor (bFGF) after caustic esophageal injury in rats. METHODS Thirty-six male rats were randomly divided into three groups. Corrosive esophageal injury was produced by internal application of 30% sodium hydroxide (NaOH) solution to the distal esophagus. Group A rats were uninjured. Group B rats were injured and untreated. Group C rats were injured and received topical bFGF (10 μg/ml). Surviving rats were killed at 28 days. The survival rate, body weight gain, symptoms and histopathological changes that included tissue damage score, ratio of esophageal luminal area/total esophageal area (LA/TA) and the proportion of a neural marker PGP 9.5-positive area were assessed. RESULTS The survival rate and the prevalence of symptoms were not significantly different between Groups B and C. Although the tissue damage score did not differ in Groups B and C, LA/TA was significantly higher in Group C than in Group B. The proportion of the PGP 9.5-positive area was significantly lower in Groups B and C than in Group A; however, it was higher in Group C than in Group B. CONCLUSION Topical application of bFGF was effective in preventing stricture after NaOH-induced esophagitis.
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Affiliation(s)
- Yuichi Okata
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Contini S, Scarpignato C, Rossi A, Strada G. Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients. J Pediatr Surg 2011; 46:1739-45. [PMID: 21929983 DOI: 10.1016/j.jpedsurg.2011.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/12/2011] [Accepted: 03/13/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up. METHODS An observational study was carried out since 2005 on all children (<15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures. Improvement in nutritional status (ie, gaining weight) and sustained esophageal patency were both considered reference points to successful treatment. RESULTS In 4 years (2005-2009), 175 children were admitted, 53.7% at more than 1 month after ingestion. Dilatations were carried out in 77.7%, and a gastrostomy was placed in 64%. Perforations and death rate were 4.5% and 2.8%, respectively. Sixty-two patients (35.4%) required more than 7 dilatations, whereas 15 (8.5%) were unable to maintain a satisfactory luminal diameter. Follow-up (range, 1-36 months; median, 7 months) was possible in 52.7%. Long-term success according to the aforementioned criteria was observed in only 16%. CONCLUSIONS Delayed presentations and complex strictures with repeated postdilatation recurrence are characteristics of children's corrosive ingestion in developing countries. Malnutrition is common, and gastrostomy is frequently compulsory. Esophageal patency with improvement in nutritional state is achieved only in a small percentage of patients.
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Affiliation(s)
- Sandro Contini
- Department of Surgical Sciences, University of Parma, Parma 43100, Italy.
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Cabral C, Chirica M, de Chaisemartin C, Gornet JM, Munoz-Bongrand N, Halimi B, Cattan P, Sarfati E. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc 2011; 26:214-21. [PMID: 21858575 DOI: 10.1007/s00464-011-1857-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 07/04/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Both observational and aggressive surgical strategies have been advocated for the treatment of corrosive injuries of the upper gastrointestinal tract (UGT) but the optimal management is still a dilemma. The aim of this study was to report our experience with caustic UGT injuries in adult patients treated with a surgically aggressive, endoscopy-based therapeutic protocol over a 6-year period. PATIENTS AND METHODS Between January 2002 and December 2007, 315 patients (138 men, mean age = 40 ± 15.5 years) were referred for corrosive UGT injuries. Emergency endoscopy was performed in all patients at admission. Patients with mild injuries (grades I-IIIa) were offered nonoperative management, whereas emergency surgery was performed for severe injuries (grades IIIb and IV). Esophageal reconstruction was offered to psychologically stable patients after emergency esophageal resection and for esophageal strictures that failed endoscopic dilation. Functional failure was defined as the impossibility to remove the jejunostomy or/and the tracheotomy tube. RESULTS At endoscopy 73 (23%) patients did not have UGT injuries, 158 (50%) patients had mild injuries eligible for nonoperative management and 84 (27%) patients had severe injuries. Nonoperative management was successful in 93% of patients with mild injuries. Surgical exploration was eventually performed in 88 (28%) patients and resection was undertaken in 76 of them. Emergency mortality was 7% and all fatalities were patients with initial severe injuries. After a median follow-up of 6 days (range = 1 day-8.5 years), functional failure was recorded in 9 (3%) patients, all of whom had initial severe injuries. CONCLUSION Emergency endoscopic grading of caustic injuries is the main factor that conditions outcome after caustic ingestion.
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Affiliation(s)
- Carmen Cabral
- Service de Chirurgie Générale, Digestive et Endocrinienne, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475, Paris Cedex 10, France
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Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res 2010; 3:235-244. [PMID: 27942303 PMCID: PMC5139851 DOI: 10.4021/gr263w] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2010] [Indexed: 12/16/2022] Open
Abstract
Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed.
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Affiliation(s)
- Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Iqbal
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Byju Kundil
- Department of GI Surgery, Lakeshore Hospital, Cochin, Kerala, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Contini S, Garatti M, Swarray-Deen A, Depetris N, Cecchini S, Scarpignato C. Corrosive oesophageal strictures in children: outcomes after timely or delayed dilatation. Dig Liver Dis 2009; 41:263-8. [PMID: 18801710 DOI: 10.1016/j.dld.2008.07.319] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/23/2008] [Accepted: 07/25/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Among benign oesophageal lesions, caustic strictures are the most difficult to dilate. In low-income countries, children suffering caustic oesophageal injury are frequently referred to the hospitals late, sometimes weeks after ingestion. Therefore, dilatation may be performed late and in highly fibrotic strictures. Reports about endoscopic and clinical outcome of such delayed dilatations are scanty. The aim of this study was to evaluate the safety and efficacy of late caustic stricture dilatations in children, comparing it with the results of timely dilatations, both performed at the Hospital of the Italian Non-Governmental Organization "Emergency" at Goderich, Sierra Leone. PATIENTS AND METHODS From December 2005 to May 2007, 78 children (<15 years) complaining alkaline caustic ingestion were submitted to oesophageal dilatation, mainly (97%) using Savary dilators. Two groups were identified: children (group 1) with a late treatment (>6 weeks, 37+/-12 weeks), having arrived to the hospital late after ingestion, and children (group 2) dilated timely, i.e. at <6 weeks (4+/-1.4 weeks) after injury. RESULTS Strictures were severe in all patients. Twenty-five children were dilated late after injury (6.4 dilatations/patient) with a follow-up of 11+/-2.5 months. A successful clinical outcome was observed in 91.6%. Four perforations (2.6% procedure-related) and one death (4.0%) were observed. Strictures recurred once in 72% of patients, twice in 31.8%. Thirty-one children were dilated timely (4.5 dilatations/patient) with a follow-up of 10+/-2.1 months and a clinical success rate of 96.7%. Procedure-related perforation rate was 0.7% with one death (3.2%). Stricture recurred once in 30% and twice in 3.3%. CONCLUSIONS Delayed dilatation of caustic oesophageal strictures in children carries a higher risk of perforation and a higher recurrence rate.
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Affiliation(s)
- S Contini
- Department of Surgical Sciences, School of Medicine & Dentistry, University of Parma, Italy.
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Pathophysiology of Caustic Ingestion. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Henry MACDA, Pelissari CEB, Carvalho LR. Morphological and functional evaluation of distal esophagus of rabbits submitted to esophageal infusion with caustic soda. Acta Cir Bras 2009; 23:16-21. [PMID: 18278388 DOI: 10.1590/s0102-86502008000100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/16/2007] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED The ingestion of caustic substances is an important emergency situation, because of its serious consequences. PURPOSE To study morphological and functional alterations of the esophagus in rabbits submitted to esophageal infusion of caustic soda (NaOH). METHODS The 88 rabbits studied were divided into 4 groups: G1 (n=22) were submitted to esophageal infusion with distilled water. G2, G3, and G4 were submitted to esophageal infusion of 2%, 4% and 6% NaOH respectively. Morphological alterations were studied in 12 animals from each group and manometric alterations in the remaining 10. An analysis was made of lower esophageal sphincter (LES) pressure, number and amplitude of contractions in the distal third of the esophagus. These studies were performed before (moment M1) and at 30 minutes, 6 hours, and 24 hours after (moments M2, M3, and M4, respectively) esophageal infusion. RESULTS Morphological evaluation: G1 - no alterations; G2 - edema, hyperemia, and ecdysis; G3 - enlarged calibre of esophagus, ulcers, ecdysis of mucosa; G4 - lesions similar to G3, but more intense, areas of extensive hemorrhage at M3 and M4. Functional evaluation: LES was higher at M2; the number of distal third lower esophageal contractions in G3, and G4 was lower; and the contraction amplitude was lower in G4. CONCLUSIONS 1) Esophageal infusion with caustic soda in rabbits is a good experimental model for studying caustic esophagites. 2) Esophageal infusion with NaOH caused lesions in the esophageal wall, with gravity proportional to solution concentration; 3) Infusion caused LES spasm at M2, and reduced both contraction number and amplitude in the distal third of the esophagus.
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Park JY, Shin JY, Yang HR, Ko JS, Kim WS, Seo JK. Usefulness of early endoscopy for predicting the development of stricture after corrosive esophagitis in children. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ji Yong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Youn Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Kee Seo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Caustic injury to the aerodigestive tract remains a significant medical and social concern despite various efforts to minimize hazards of caustic household products. Agents with a pH less than two or greater than 12 are extremely corrosive, causing damage that can range from mild to extensive, including esophageal perforation leading to mediastinitis and death at the extreme scale. Methods include retrospective case note review of all admissions to the otolaryngology unit with caustic injury that underwent esophagoscopy to the Children's Hospital Westmead between 1990 and 2007. A protocol-based management system with antibiotics and steroids together with esophagoscopy at 48 hours was implemented. A total of 50 admissions were identified with an average follow-up of 5 years. There were a total of 28 males and 22 females with a median age of 22 months. Forty-nine cases (98%) were accidental. Thirty-eight cases (76%) occurred within the interiors of the family home with the kitchen being the common location. Another seven (14%) occurred within the external environment of the home, usually in the garage or pool shed. The causative agents were varied with 37 (74%) being alkali, three cases (6%) being acidic, and other agents, such as chlorine bleach, being the remainder. The most frequently ingested alkalis were dishwashing powder and disinfectants closely followed by degreasers. Twenty-five children (50%) drank directly from a container with the remainder ingesting granules or powder directly. At esophagoscopy, 17 cases (34%) had grade 1 injury and 10 (20%) had grade 2 injury. Fifty percent of patients of grade 2 injury subsequently developed strictures requiring multiple dilatations. Importantly, six cases (12%) had evidence of esophageal injury without oral injury. Caustic injuries continue to be a significant morbidity in the pediatric patient group. Most cases are still happening as a result of accidental ingestion from unmarked containers within reach of children at home. Oral injury is not always a useful marker of more significant distal injury. A protocol-based management can identify children at risk for long-term stricture earlier.
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Affiliation(s)
- F Riffat
- Department of Otolaryngology, Children's Hospital Westmead, Westmead NSW, Australia
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The efficacy of ozone therapy in experimental caustic esophageal burn. J Pediatr Surg 2008; 43:1679-84. [PMID: 18779006 DOI: 10.1016/j.jpedsurg.2008.01.064] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 01/11/2008] [Accepted: 01/21/2008] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Ozone has been proposed as an antioxidant enzyme activator, immunomodulator and cellular metabolic activator. This study was designed to investigate the efficacy of ozone therapy in the prevention of esophageal damage and stricture formation developed after esophageal caustic injuries in the rat. MATERIALS AND METHODS Forty-five rats were allocated into three groups; sham-operated, un-treatment and treatment groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 1 mg/kg/day ozone intraperitoneally. All rats were sacrificed at 28 days. Efficacy of the treatment was assessed by measuring the stenosis index (SI) and histopathologic damage score, and biochemically by determining tissue hydroxyproline content (HP), superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA) and protein carbonyl content (PCC) in esophageal homogenates. RESULTS Whereas seven (47%) rats died in the un-treatment group, all rats in the sham-operated and the treatment group survived during the study. SI, the histopathologic damage score, was significantly lower in the ozone-therapy group than the un-treatment group. HP levels were significantly higher in the un-treatment group than the group treated with ozone. Caustic esophageal burn increased MDA and PCC levels and also decreased SOD and GPx enzyme activities. In contrast, ozone therapy decreased the elevated MDA and PCC levels and also increased the reduced SOD and GPx enzyme activities. CONCLUSION Ozone has a preventive effect in the development of fibrosis by decreasing tissue damage and increasing the antioxidant enzyme activity in an experimental model of corrosive esophageal injury.
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Keh SM, Onyekwelu N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol 2006; 12:5223-8. [PMID: 16937538 PMCID: PMC4088025 DOI: 10.3748/wjg.v12.i32.5223] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed and developing countries, corrosive injury to the gastrointestinal system as a consequence of either accidental ingestion or as a result of self-harm has become a less common phenomenon compared to decades ago. This could partly be attributed to the tighter legislation imposed by the government in these countries on detergents and other corrosive products and general public awareness. Most busy upper gastrointestinal surgical units in these countries, especially in the developed countries will only encounter a small number of cases per year. Up to date knowledge on the best management approach is lacking. In this article, we present our experience of two contrasting cases of corrosive injury to the upper gastrointestinal tract in our thoracic unit in the last 2 years and an up-to-date Medline literature search has been carried out to highlight the areas of controversies in the management of corrosive injuries of the upper gastrointestinal tract. We concluded that the main principle in managing such patients requires a good understanding of the pathophysiology of corrosive injury in order to plan both acute and future management. Each patient must be evaluated individually as the clinical picture varies widely. Signs and symptoms alone are an unreliable guide to injury.
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Affiliation(s)
- Siew Min Keh
- The Royal National Nose, Throat and Ear Hospital, London, WC1X 8DA, United Kingdom.
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19
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Chiu HM, Lin JT, Huang SP, Chen CH, Yang CS, Wang HP. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc 2004; 60:827-33. [PMID: 15557970 DOI: 10.1016/s0016-5107(04)02031-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury. METHODS Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded. OBSERVATIONS All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff. CONCLUSIONS EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Ozel SK, Dagli TE, Yuksel M, Kiyan G, Kotiloglu E. The roles of free oxygen radicals, nitric oxide, and endothelin in caustic injury of rat esophagus. J Pediatr Surg 2004; 39:1381-5. [PMID: 15359394 DOI: 10.1016/j.jpedsurg.2004.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The authors aimed to find out the roles of free oxygen radicals, nitric oxide (NO), and endothelin (ET) in caustic injury of rat esophagus. METHODS Forty-five Wistar albino rats were used to form 6 groups. The study groups are summarized as 1, sham (S; n = 7); 2, sham + L-arginine (SA; n = 7); 3, sham + L-NAME (SN; n = 7); 4, injury (I; n = 8); 5, injury + L-arginine (IA; n = 8); 6, injury + L-NAME (IN; n = 8). Normal saline in the sham groups and 50% NaOH in the caustic injury groups were administered to the distal esophagus. Free oxygen radicals and NO were detected by chemiluminescence from tissue samples, and they were correlated with histologic examinations. Tissue ET was measured also with immunohistochemistry. RESULTS The injury was verified histologically. Free oxygen radical levels were found to be increased as well as NO and ET with the caustic injury (P <.05). L-arginine caused a histologic increase in the injury that was close to statistical significance (P =.08). L-NAME showed no significant effect. CONCLUSIONS Free radicals, NO, and ET increase in the early phase of caustic esophageal injury. Understanding their early interactions during the caustic injury may help in future therapeutic strategies.
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Affiliation(s)
- S Kerem Ozel
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
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21
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Zwischenberger JB, Savage C, Bidani A. Surgical aspects of esophageal disease: perforation and caustic injury. Am J Respir Crit Care Med 2002; 165:1037-40. [PMID: 11956041 DOI: 10.1164/ajrccm.165.8.2104105] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joseph B Zwischenberger
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77555-0528, USA.
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22
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de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhinolaryngol 2001; 57:203-11. [PMID: 11223452 DOI: 10.1016/s0165-5876(00)00440-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Caustic ingestion with resultant corrosive esophagitis in the pediatric population comprises a heterogeneous group in terms of offending agent, location of burn and the degree of damage. Consequently, the treatment of these injuries has also varied over the years and the optimal management remains controversial. Another area of concern that is seldom reported in the otolaryngology literature is the socioeconomic impact of such injuries both on the child and on the family. We report a 30-year retrospective review of aerodigestive tract caustic injuries at The Hospital for Sick Children. Eighty patients were identified with an age range from 1 month to 16 years. Early and late complications are reviewed including 23 patients (29%) that developed medical complications and 16 patients (20%) that developed severe esophageal strictures. Five of these children required repeat prograde dilatation, while 11 children required gastrostomy and stringing with subsequent retrograde dilatation. All the 11 children required esophageal replacement surgery. The economic and social consequences to the child and family were also noted with particular attention to hospital costs, parental absenteeism from work, and the need for job relocation. A partial cost analysis using a child with a severe injury is presented as an example. Psychological aspects such as attempted murder, jail terms and attempted suicides are also documented. We also present an analysis of those children requiring esophageal replacement surgery, and examine the possible role of esophageal stents in recalcitrant strictures.
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Affiliation(s)
- A L de Jong
- The Department of Otolaryngology, The Hospital for Sick Children, 555 University Avenue, Ont., M5G 18X, Toronto, Canada
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23
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Rha SE, Ha HK, Lee SH, Kim JH, Kim JK, Kim JH, Kim PN, Lee MG, Auh YH. CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics 2000; 20:29-42. [PMID: 10682769 DOI: 10.1148/radiographics.20.1.g00ja0629] [Citation(s) in RCA: 229] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ischemic bowel disease represents a broad spectrum of diseases with various clinical and radiologic manifestations, which range from localized transient ischemia to catastrophic necrosis of the gastrointestinal tract. The primary causes of insufficient blood flow to the intestine are diverse and include thromboembolism, nonocclusive causes, bowel obstruction, neoplasms, vasculitis, abdominal inflammatory conditions, trauma, chemotherapy, radiation, and corrosive injury. Computed tomography (CT) or magnetic resonance (MR) imaging can demonstrate the ischemic bowel segment and may be helpful in determining the primary cause. The CT and MR imaging findings include bowel wall thickening with or without the target sign, intramural pneumatosis, mesenteric or portal venous gas, and mesenteric arterial or venous thromboembolism. Other CT findings include engorgement of mesenteric veins and mesenteric edema, lack of bowel wall enhancement, increased enhancement of the thickened bowel wall, bowel obstruction, and infarction of other abdominal organs. However, regardless of the primary cause, the imaging findings of bowel ischemia are similar. Furthermore, the bowel changes simulate inflammatory or neoplastic conditions. Understanding the pathogenesis of various conditions leading to mesenteric ischemia helps the radiologist recognize ischemic bowel disease and avoid delayed diagnosis, unnecessary surgery, or less than optimal management.
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Affiliation(s)
- S E Rha
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Ku, Seoul, Korea
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24
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Bingöl-Kologlu M, Tanyel FC, Müftüoğlu S, Renda N, Cakar N, Büyükpamukçu N, Hiçsönmez A. The preventive effect of heparin on stricture formation after caustic esophageal burns. J Pediatr Surg 1999; 34:291-4. [PMID: 10052807 DOI: 10.1016/s0022-3468(99)90193-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/PURPOSE Preventing thrombus formation after caustic esophageal ingestion has been proposed to have beneficial effects. Therefore, an experimental study was carried out to investigate the effects of heparin on the esophagus after caustic burns. METHODS Caustic esophageal burns were produced in rats by irrigation with 50% NaOH as described by Liu. Rats were divided into four groups as follows: group A, animals with esophageal burns, received placebo and underwent autopsy 48 hours after caustic injury; group B, animals with esophageal burns, received subcutaneous heparin treatment and underwent autopsy 48 hours after caustic injury; group C, animals with esophageal burns, received placebo and underwent autopsy 28 days after caustic injury; group D, animals with esophageal burns, received subcutaneous heparin treatment for 7 days and underwent autopsy 28 days after caustic injury. Histopathologic evaluation was performed in all groups, and collagen content of esophageal sections was analyzed by determination of hydroxyproline levels. RESULTS Submucosal vascular thrombosis was encountered in all group A animals but the submucosal venules and arterioles were patent in most of group B animals. Esophageal strictures did not develop in any of group D animals, although varying degree of esophageal stenoses were encountered in all animals of group C. The circumferences of the burned segment have been narrowed to 3+/-1 mm in group C rats. There was obvious collagen deposition in submucosa, and epithelial regeneration was not complete in group C rats. Submucosa and epithelial integrity seemed normal in group D animals. Hydroxyproline contents in group D were significantly lower compared with group C (P < .05). CONCLUSIONS Heparin has ameliorating effects on stricture formation after caustic esophageal burn. Those effects may occur through possible anticoagulant, antithrombotic, and endothelial protective effects, and modifying effects of heparin on wound healing.
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Affiliation(s)
- M Bingöl-Kologlu
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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25
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Homan CS, Singer AJ, Thomajan C, Henry MC, Thode HC. Thermal characteristics of neutralization therapy and water dilution for strong acid ingestion: an in-vivo canine model. Acad Emerg Med 1998; 5:286-92. [PMID: 9562189 DOI: 10.1111/j.1553-2712.1998.tb02706.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether in-vivo neutralization therapy for acid ingestions will superimpose a thermal injury upon tissue already damaged by acid. METHODS An in-vivo canine model was used with repeated measures of tissue and luminal temperatures. All dogs were placed under halothane general anesthesia. The stomach was exteriorized and temperature probes were placed in the lumen and mucosa. 25 mL of 0.5 N HCl (25 degrees C) was placed in the gastric lumen followed 5 minutes later by 75 mL of either 8% NaHCO3 neutralization (25 degrees C, n = 10) or water dilution (25 degrees C, n = 10). Temperature measurements were recorded at specified intervals for 5 minutes post HCl acid exposure and for 30 minutes post treatment. Temperature profiles were analyzed by repeated-measures ANOVA. Post-treatment changes were evaluated using signed-rank tests. RESULTS In both treatment groups, treatment resulted in significant decreases in initial mucosa and intraluminal temperatures. Both the mucosa and intraluminal temperatures decreased immediately after treatment with HCO3 by an average of 1.6 degrees C (p = 0.05). In the water dilution treatment group, both temperatures decreased by 1.1 degrees C (p = 0.05). Ensuing post-treatment temperatures increased but did not reach baseline temperatures at any time up to 30 minutes post treatment. CONCLUSIONS In the in-vivo setting, there is no evidence of hazardous temperature elevation when a weak alkali or dilution therapy is used to neutralize strong acid-induced injury. Contraindication of this form of emergency treatment should not be based on the preconceived idea that a resultant exothermic reaction will cause a superimposed thermal injury. Further clinical study is needed to determine the clinical utility of this emergency therapeutic modality.
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Affiliation(s)
- C S Homan
- Department of Emergency Medicine, State University of New York at Stony Brook, University Medical Center, 11794-7400, USA.
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26
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Affiliation(s)
- R Hijazeen
- Department of Pediatrics, King Hussein Medical Center, Amman, Jordan
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27
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Abstract
Hair relaxer, a commercially available alkaline product, is commonly the offending agent in caustic ingestion. These patients often experience oral cavity and facial burns; however, no clinically significant esophageal injuries have been reported. Therefore, we questioned the therapeutic and economic efficacy of the "standard treatment protocol" that includes hospitalization and endoscopic evaluation. Twenty-six patients over a 7-year period presented to our institution having ingested hair relaxer. Presenting signs and symptoms, esophageal findings, and cost of the standard treatment protocol were reviewed. Also, we analyzed the caustic potential and current packaging of hair relaxer. Our findings support modifications in the standard treatment protocol for hair relaxer ingestion including elimination of hospitalization and endoscopy in most patients. We also question compliance with childproof packaging laws and suggest avenues for prevention of hair relaxer ingestion.
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Affiliation(s)
- A J Cox
- Cardinal Glennon Children's Hospital, Department of Otolaryngology, Saint Louis, Missouri 63110-0250, USA
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28
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Berkovits RN, Bos CE, Wijburg FA, Holzki J. Caustic injury of the oesophagus. Sixteen years experience, and introduction of a new model oesophageal stent. J Laryngol Otol 1996; 110:1041-5. [PMID: 8944879 DOI: 10.1017/s0022215100135716] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Caustic ingestion can lead to oesophageal stenosis. We studied 251 patients, 205 of whom were children, in a sixteen-year period. Seventeen patients, of whom one was an adult, acquired deep burns in the oesophagus which had to be treated, to prevent the development of oesophageal strictures. These patients were treated with long-term stenting of the oesophagus with specially designed, silicone rubber stents, impregnated with silicone oil 20 cS, designed by one of us (R.N.P.B.) as the only treatment. Of all models, the twin-tube dilator was the most satisfactory. No corticosteroids were administered. Only one patient developed a mild stenosis. It is therefore our opinion that, when life-saving operations are not indicated, twin-tube stenting of the oesophagus is helpful in treating caustic lesions of the oesophagus and will prevent stricture formation. Corticosteroids were not given in this series, and should be abandoned in the treatment of caustic lesions.
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Affiliation(s)
- R N Berkovits
- Department of Otolaryngology, University Hospital Rotterdam, The Netherlands
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29
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Shikowitz MJ, Levy J, Villano D, Graver LM, Pochaczevsky R. Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success. Laryngoscope 1996; 106:1-12. [PMID: 8569409 DOI: 10.1097/00005537-199602001-00001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.
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Affiliation(s)
- M J Shikowitz
- Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA
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30
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Abstract
A total of 102 children less than 16 years of age admitted for caustic ingestion in the period 1976-1991 were registered. The annual incidence rate of hospitalization was 10.8:100,000 for the city of Aarhus, Denmark. Esophageal burns occurred with a frequency of 5.0:100,000 per year. Ninety-four percent of the children were less than 5 years old. For this age group, the incidence rates of admission and esophageal burns were 34.6:100,000 and 15.8:100,000, respectively. All ingestions were accidental. The incidence rates of esophageal burns in children 0-4 years old (p = 0.019) decreased significantly during the period studied. The cause of this decrease is not clear, but a change in the spectrum of household products and the gradual introduction of child-proof caps are possible explanations. To minimize the frequency of accidents, an information campaign directed specifically at parents of toddlers is recommended. Information material should stress that caustics should always be inaccessible to children and stored separately, and should never be decanted.
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Affiliation(s)
- H B Christesen
- Department of Pediatrics, Aarhus Municipal Hospital, Denmark
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31
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Abstract
Strong acid ingestion produces distinctly different injuries from alkali burns. Alkali burns are well described but the lack of literature on the diagnosis and management of acid burns is apparent. This retrospective review of 18 patients with battery acid (30% sulphuric acid) ingestion showed no correlation between the severity of the symptomatology and the degree of injury. The quantity of acid needed to cause a significant upper GIT burn was more than 200 ml. Previous reports that acid spared the oesophagus due to rapid transit were disproved, since oesophageal involvement was found in 55% (10/18). Deep burns rather than circumferential burns resulted in stricture formation. The major injury site was the gastric antrum with 4 patients (23%) requiring surgical intervention to restore function.
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Affiliation(s)
- P J Wormald
- Department of Otolaryngology, Groote Schuur Hospital, Cape Town, South Africa
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32
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Howell JM, Dalsey WC, Hartsell FW, Butzin CA. Steroids for the treatment of corrosive esophageal injury: a statistical analysis of past studies. Am J Emerg Med 1992; 10:421-5. [PMID: 1642705 DOI: 10.1016/0735-6757(92)90067-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Caustic esophageal injury causes substantial morbidity and mortality. However, the use of corticosteroids to treat this problem has been evaluated in a limited number of studies because adequate sample size is difficult to obtain. We analyzed 361 subjects with corrosive esophageal injury derived from 10 retrospective and three prospective publications. We divided cases into those treated with corticosteroids and antibiotics (T) and those that received neither modality (NT) based on inclusion and exclusion criteria. Forty-one percent of NT cases developed esophageal stricture and 19% of T cases developed this complication (P less than .01). There were no reported strictures among 72 first-degree esophageal burns (combined T and NT cases). The T group contained 54 strictures among 228 patients (24%) with either second- or third-degree burns. The NT group of 25 patients with the same burn severity suffered 13 strictures (52%) (P less than .01). Reports of death and gastrointestinal hemorrhage did not increase among steroid-treated patients. We do not recommend corticosteroid therapy for first-degree esophageal injuries. However, this therapy may be useful in preventing strictures among patients with second- or third-degree corrosive esophageal burns.
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Affiliation(s)
- J M Howell
- Department of Emergency Medicine, Georgetown University Hospital, Washington, DC
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Orvar K, Fagel D, Summers RW. Savary dilation of antral stricture from lye ingestion. Gastrointest Endosc 1992; 38:512-3. [PMID: 1511832 DOI: 10.1016/s0016-5107(92)70491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- K Orvar
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242
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34
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Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, Oderda GM, Benson B, Litovitz T, McCormick M, McElwee N, Spiller H, Krenzelok E. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med 1992; 10:189-94. [PMID: 1586425 DOI: 10.1016/0735-6757(92)90206-d] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The predictive value of initial clinical evaluation in the management of alkaline corrosive ingestion remains unclear. This multicenter study was designed to determine if specific clinical signs and symptoms following ingestion of alkaline corrosives could predict significant esophageal injury. Alkaline corrosives were defined by a pH greater than or equal to 12. Signs and symptoms previously suggested as predictive of significant esophageal injury were documented on a standardized data form. Esophagoscopy reports were reviewed blinded to initial symptoms. Three hundred thirty-six alkaline-corrosive ingestions were analyzed. The mean number of symptoms reported in patients who did not have esophagoscopy was 1.2, in patients who had esophagoscopy was 3.0, and in patients that had visualized second or third degree esophageal burns was 4.8. Of 88 patients who had esophagoscopy, 63 (72%) had both the esophagoscopy report and initial symptom assessment available. Esophagoscopy was positive, defined as second or third degree esophageal burns, in 18 of 63 cases (29%). All patients with significant burns were symptomatic. No single or group of initially reported signs and symptoms could identify all patients with potentially serious esophageal burns.
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35
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Howell JM. Alkalinity of non-industrial cleaning products and the likelihood of producing significant esophageal burns. Am J Emerg Med 1991; 9:560-2. [PMID: 1930399 DOI: 10.1016/0735-6757(91)90114-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Alkaline cleaning products are a cause of serious esophageal injury. Over time, legislation has diminished the concentration of many such non-industrial solutions and solids; however several products presently do not list either the pH or relative concentrations of alkaline constituents. This study measures the pHs of several non-industrial cleaning products containing either ammonium chloride, sodium hydroxide, or potassium hydroxide. Three pH measurements were performed on each of 10 non-industrial alkaline cleaning products (eight liquid, two solid). Two 0.1% ammonium chloride solutions had pHs of 12.06 +/- 0.00 and 12.06 +/- 0.01, whereas a pH of 12.43 +/- 0.00 was recorded in a 0.2% ammonium chloride solution. Concentrations of sodium hydroxide and potassium hydroxide were listed on only one of five liquid cleaning product labels. The pHs for these five products varied between 12.83 +/- 0.009 and 13.5 +/- .0.2. The pHs of three sodium hydroxide solutions differed from values reported in Micromedex (Micromedex Inc, Denver CO) by up to 0.32 pH units. Ten percent (v/v) solutions of two solid lye products had pHs of 13.62 +/- 0.008 and 13.74 +/- 0.02. The investigator found that selected non-industrial cleaning products, including ammonia solutions, retain the ability to cause clinically important esophageal damage.
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Affiliation(s)
- J M Howell
- North East Ohio Universities College of Medicine, Akron, OH
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36
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Abstract
Eight patients with severe hydrochloric acid injury of the esophagus and stomach had early esophagogastrectomy. Four patients survived and 6 to 8 weeks later underwent successful substernal colon replacement. The value of early diagnosis and subsequent aggressive surgical management of patients who have ingested hydrochloric acid is stressed.
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Affiliation(s)
- O P Horváth
- Department of Surgery and Anesthesiology, Albert Szent-Györgyi Medical University, Hungary
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37
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Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 1990; 323:637-40. [PMID: 2200966 DOI: 10.1056/nejm199009063231004] [Citation(s) in RCA: 260] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is controversial whether treatment with corticosteroids reduces stricture formation in the esophagus after the ingestion of caustic material. METHODS We conducted a prospective study over an 18-year period in which 60 children (median age, 2 years) with esophageal injury from the ingestion of caustic material were assigned randomly to treatment either with or without corticosteroids. The corticosteroids were given initially as prednisolon (2 mg per kilogram of body weight per day intravenously) and then as prednisone orally to complete a three-week course. All patients were evaluated by esophagoscopy within 24 hours of the ingestion. Those with moderate or severe esophageal injury had repeat esophagoscopy and barium swallow at follow-up. RESULTS Esophageal strictures developed in 10 of the 31 children treated with corticosteroids and in 11 of the 29 controls (P not significant). Four children in the steroid group and seven in the control group eventually required esophageal replacement (P not significant). All but 1 of the 21 children with strictures had severe circumferential burns on initial esophagoscopy. CONCLUSIONS There appears to be no benefit from the use of steroids to treat children who have ingested a caustic substance. The development of esophageal stricture was related only to the severity of the corrosive injury.
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Affiliation(s)
- K D Anderson
- Department of Surgery, Children's National Medical Center, Washington, DC 20010
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38
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Abstract
This article reviews the management of patients following caustic ingestion. The initial care is conservative, consisting mainly of IV antibiotics and steroids. Patency of the airway is of immediate concern and achieved via either intubation or tracheostomy. Early intervention with oral splint therapy is recommended to minimize scar contracture. It is important that the oral and maxillofacial surgeon be acquainted with the primary care of such patients, as well as with the subsequent management of the secondary complications of decreased stomal opening, loss of the mucobuccal fold, and limitation of tongue movement.
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Affiliation(s)
- M M Rubin
- Department of Oral and Maxillofacial Surgery, Nassau County Medical Center, East Meadow, NY
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Broor SL, Kumar A, Chari ST, Singal A, Misra SP, Kumar N, Sarin SK, Vij JC. Corrosive oesophageal strictures following acid ingestion: clinical profile and results of endoscopic dilatation. J Gastroenterol Hepatol 1989; 4:55-61. [PMID: 2490943 DOI: 10.1111/j.1440-1746.1989.tb00807.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There are several reports on oesophageal strictures caused by alkali ingestion, but information on oesophageal strictures due to acid ingestion is scarce. Endoscopic dilatation, which has been found to be quite safe and effective in the treatment of benign oesophageal strictures of other aetiology, has also not been evaluated adequately in the treatment of these strictures. Over a period of 2 years, of 47 patients treated at this centre of benign oesophageal strictures, 17 (36.2%) patients had strictures following ingestion of corrosive agents. Thirteen patients had ingested acids and only four gave a history of alkali ingestion. The age range of these 13 patients was 14-50 years (mean = 25.5 years, s.d. = 2.6). The amount of acid ingested varied from 10 to 100 ml (median = 50 ml). The interval between acid ingestion and presentation to hospital ranged from 1 to 60 months (median = 2 months). Ten patients had multiple strictures, and the most common site of involvement was the upper third followed by the lower third of the oesophagus. Only five of these 13 patients had evidence of gastric involvement in the form of antral stricture (four) and hour glass deformity (one). Strictures were dilated using Eder-Puestow metal olives passed over a guide wire. The total number of sittings required to achieve adequate dilatation in this group ranged from 1 to 30 (median = 14). Most patients were managed successfully with dilatation (good response 63.6%, satisfactory response 18.2%). On follow-up, recurrence of dysphagia was seen in a high number of patients (66%), but this could be managed easily with repeat dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S L Broor
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
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40
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Ferguson MK, Migliore M, Staszak VM, Little AG. Early evaluation and therapy for caustic esophageal injury. Am J Surg 1989; 157:116-20. [PMID: 2910116 DOI: 10.1016/0002-9610(89)90430-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Forty-one patients with caustic ingestion were reviewed. Eighty-three percent were children, all of whom suffered accidental injury. Liquid drain cleaner was the agent in 57 percent and was responsible for all esophageal burns. Symptoms and physical findings were unreliable in predicting the extent of injury. Endoscopy was performed in most patients within 36 hours of ingestion and accurately estimated the risk of subsequent esophageal stricture formation. Steroid administration had no influence on the development of strictures. Esophageal strictures developed in 22 percent of the patients. One-third were successfully managed by periodic dilation, whereas the remaining two-thirds required esophagectomy and reconstruction. Early endoscopic evaluation was the best means of assessing the degree of injury after caustic ingestion. Routine steroid administration had no apparent clinical benefit.
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Affiliation(s)
- M K Ferguson
- Department of Surgery, University of Chicago Medical Center, Illinois 60637
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41
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Pense SC, Wood WJ, Stempel TK, Zwemer FL, Wachtel TL. Tracheoesophageal fistula secondary to muriatic acid ingestion. Burns 1988; 14:35-8. [PMID: 3370514 DOI: 10.1016/s0305-4179(98)90039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acid ingestion may result in a variety of early and late complications. A patient is presented with severe sequelae from muriatic acid ingestion, including a tracheoesophageal fistula which is a previously unreported complication of acid ingestion injury. Recommendations are made for diagnosis and prevention of this potentially lethal complication.
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Affiliation(s)
- S C Pense
- Phoenix Integrated Surgical Residency
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42
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Friedman EM. Caustic ingestions and foreign body aspirations: an overlooked form of child abuse. Ann Otol Rhinol Laryngol 1987; 96:709-12. [PMID: 3688764 DOI: 10.1177/000348948709600621] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Caustic ingestions and foreign body aspirations are common occurrences in the pediatric population. The high association between caustic ingestions and foreign body aspirations and family stress with social problems may result in significant morbidity and mortality. It is the purpose of this article to increase physician awareness concerning the possibility that these events may be a form of child abuse. It is hoped that by recognizing the risk of child abuse in these cases the physician can make the appropriate referrals in order to avoid serious injury to the child.
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Affiliation(s)
- E M Friedman
- Department of Otolaryngology, Harvard Medical School, Children's Hospital, Boston, MA 02115
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43
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Gossot D, Sarfati E, Celerier M. Early blunt esophagectomy in severe caustic burns of the upper digestive tract. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36280-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Vanker EA. Colon bypass from the oral cavity. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Abstract
A case of an unusual caustic ingestion involving Compound W, an over the counter wart remover is presented. Chemical burns of the tongue, pharynx and larynx developed. The active ingredient in this preparation: salicylic acid in a flexible collodion vehicle produces caustic injury through a keratolytic action, which may be enhanced by the presence of collodion.
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46
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Abstract
Alkaline ingestion is a potentially life-threatening problem that may confront the emergency physician. It is similar to many other toxins in that children and those who attempt suicide are its most common victims; however, implications in terms of initial stabilization and definitive care are quite distinct. Mucosal exposure to lye results in a quick, deep liquefactive necrosis. Consequently, blind nasotracheal intubation may result in the perforation of damaged tissues in the pharynx and trachea. For similar reasons, the blind passage of a nasogastric tube is contraindicated. The use of diluents in this setting is controversial. If a diluent is used, water and milk are considered the liquids of choice. They may be used to irrigate oropharyngeal burns, but are contraindicated in the face of respiratory compromise, shock, liquid lye ingestion, and perforation of the esophagus or stomach. Cathartics and charcoal are not used after alkaline ingestion. Cathartics, however, are used in miniature alkaline battery ingestions to diminish bowel transit time. Esophagoscopy should be done within 12 to 24 hours after ingestion to directly observe the extent of damage. This procedure should be stopped at the first sign of injury to protect against iatrogenic esophageal perforation. Steroids should be started for circumferential esophageal burns and in those patients with significant injury who are unable to undergo esophagoscopy. IV antibiotics are administered for gastrointestinal perforation and may be used concomitantly with steroids. Miniature alkaline batteries lodged in the esophagus must be removed immediately. The available modalities include fluoroscopy-directed Foley catheter removal, endoscopy, and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
Seven children with deep circumferential esophageal burns were treated with antibiotics, steroids, and intraluminal silastic stents. Strictures did not develop if the esophagus was healed at the time the stent was removed. However, strictures developed if healing was incomplete. Esophageal stenting needs to be continued until healing has been demonstrated endoscopically.
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48
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Abstract
The ingestion of caustic chemical agents, usually accidentally by children, produces a wide range of injuries from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment for the average burn is fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy to prevent more serious complications.
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49
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Abstract
Over a six-month period, the New Jersey Poison Information System received 61 calls related to exposures to alkaline corrosives. Seven of these calls related to a new oven-cleaner product, oven-cleaner pads. These pads are sealed in a protective plastic wrap and contain lye in excess of 5%. Use of these products requires careful opening of the seal and caution in application. Five of the callers sustained injuries from their exposure, and three of these sustained burns, one in the oral cavity and one in the eye. None suffered permanent sequelae, but the potential for such is considerable. The method of application, concentration of base, and prolonged exposure to a widely covered area may make this product particularly hazardous.
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50
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Abstract
Chemical burns of the mouth, pharynx, and digestive passages have been reviewed in regard to the nature of the injury and wound description. Fabrication of custom mouth protectors to minimize oral scar contracture and its sequelae has been described. Mouth protectors provide flexible but active resistance to the forces of scar contracture and avoid a constant unyielding force that could cause pressure necrosis. Protectors are easy to fabricate and adjust, and permit movement and function of the injured area.
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