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Makarov AV, Yartsev PA, Teterin YS, Simonova AY, Tatarinova EV, Potskhveriya MM. [The role of endosonography in the treatment of chemical ulcerative-necrotic burns of the esophagus]. Khirurgiia (Mosk) 2023:106-112. [PMID: 37379413 DOI: 10.17116/hirurgia2023071106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The authors present ultrasonography-assisted endoscopic diagnosis of chemical burn of the esophagus. This method early predicted decompensated cicatricial stenosis of the esophagus that was valuable to determine treatment strategy. Preventive mini-invasive endoscopic percutaneous gastrostomy provided adequate enteral nutrition in a patient with decompensated esophageal stenosis before reconstructive surgery.
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Affiliation(s)
- A V Makarov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - Yu S Teterin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A Yu Simonova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E V Tatarinova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M M Potskhveriya
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Caustic Ingestion: A Risk-Based Algorithm. Am J Gastroenterol 2022; 117:1593-1604. [PMID: 36194047 DOI: 10.14309/ajg.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Caustic ingestion management could be improved with a diagnostic approach based on risk factors. This study aimed to develop an algorithm derived from predictive factors of a poor clinical course, to evaluate its diagnostic accuracy and resource consumption, and to compare it with 2 other approaches, a radiological one based on computed tomography and a classical one based on symptoms and endoscopy. METHODS All patients older than 15 years presenting with caustic ingestion in our tertiary care hospital between 1995 and 2021 were prospectively included. Adverse outcome was defined as intensive care unit admission, emergency surgery, or death. Ingestion characteristics, symptoms, and laboratory and endoscopic findings were analyzed to determine the most relevant risk factors. Diagnostic accuracy and the number of examinations required were estimated and compared with the other 2 algorithms applied to our series. RESULTS The sample included 532 cases of caustic ingestion, 13.2% (95% confidence interval [CI]: 10.3-16.0) of which had adverse outcomes. Volume and type of caustic substance; presence of symptoms and pharyngolaryngeal involvement; and neutrophilia, acidosis, and endoscopic injury were combined to develop an algorithm that would provide the highest diagnostic odds ratio (167.2; 95% CI: 71.9-388.7). Following this approach, half of the patients (50.6%; 95% CI: 46.2-55.1) would not require any examination and, overall, the need for endoscopy (20.0%; 95% CI: 16.4-23.5) and computed tomography (16.3%; 95% CI: 13.0-19.5) would be lower than that for the other 2 algorithms. DISCUSSION A risk-based algorithm could improve caustic ingestion management by maintaining high diagnostic accuracy while reducing diagnostic test requirements.
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Updates on the Evaluation and Management of Caustic Exposures. Emerg Med Clin North Am 2022; 40:343-364. [DOI: 10.1016/j.emc.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ramchandani M. Management of caustic injury: better to evaluate patient as a "whole" rather than only through a "hole"! Endoscopy 2021; 53:792-794. [PMID: 34315179 DOI: 10.1055/a-1381-7825] [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: 12/10/2022]
Affiliation(s)
- Mohan Ramchandani
- Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Tosca J, Villagrasa R, Sanahuja A, Sanchez A, Trejo GA, Herreros B, Pascual I, Mas P, Peña A, Minguez M. Caustic ingestion: development and validation of a prognostic score. Endoscopy 2021; 53:784-791. [PMID: 33096569 DOI: 10.1055/a-1297-0333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Caustic ingestion is a potentially severe condition and early identification of poor outcome is essential to improve management; however, prediction based on endoscopy alone can overestimate severity. This study aimed to develop and validate a prognostic score. METHODS A prospective cohort study was designed to include all consecutive patients aged > 15 years who presented with caustic ingestion between 1995 and 2017. Adverse outcome was defined by intensive care unit admission, urgent surgery, or death. The predictive value of clinical, analytical, and endoscopic variables was assessed in the first cohort (derivation cohort) and a prognostic score based on the resulting risk factors was developed by logistic regression. Internal validation (bootstrapping) was performed and then external validation was checked in an independent sample of patients (validation cohort). RESULTS 469 cases of caustic ingestion were included, 265 in the derivation cohort and 204 in the validation cohort. Ingestion of acidic substances (odds ratio [OR] 3.13, 95 % confidence interval [CI] 2.33 - 4.21), neutrophil count (OR 1.05, 95 %CI 1.04 - 1.06), metabolic acidosis (bicarbonate value, OR 0.82, 95 %CI 0.78 - 0.85), and endoscopic injury (OR 3.81, 95 %CI 3.35 - 4.34) were independent risk factors for poor outcome. The prognostic score based on these variables provided better accuracy than endoscopy alone (P = 0.04), with high sensitivity, specificity, positive and negative predictive values (93.3 %, 92.7 %, 72.7 %, 98.5 %, respectively), and area under the curve (0.976, 95 %CI 0.973 - 0.979; P < 0.001). CONCLUSIONS This score allowed a reliable prognosis of caustic ingestion and was more accurate than endoscopy-based evaluation.
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Affiliation(s)
- Joan Tosca
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Rosana Villagrasa
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Ana Sanahuja
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Ana Sanchez
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Galo Antonio Trejo
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Belen Herreros
- Department of Digestive Medicine, Hospital de la Marina Baixa de la Vila Joiosa, Alicante, Spain
| | - Isabel Pascual
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Pilar Mas
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Andres Peña
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
| | - Miguel Minguez
- Department of Digestive Medicine, Hospital Clínic Universitari, Universitat de Valencia, Valencia, Spain
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Kamat R, Gupta P, Reddy YR, Kochhar S, Nagi B, Kochhar R. Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features. Indian J Radiol Imaging 2021; 29:6-13. [PMID: 31000935 PMCID: PMC6467036 DOI: 10.4103/ijri.ijri_349_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed.
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Affiliation(s)
- Rohan Kamat
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India
| | - Yalaka Rami Reddy
- Department of Gastroenterology, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India
| | - Suman Kochhar
- Department of Radiodiagnosis and Imaging, GMCH, Chandigarh, India
| | - Birinder Nagi
- Department of Gastroenterology, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India
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Li Y, Langworthy J, Xu L, Cai H, Yang Y, Lu Y, Wallach SL, Friedenberg FK. Nationwide estimate of emergency department visits in the United States related to caustic ingestion. Dis Esophagus 2020; 33:5780187. [PMID: 32129451 DOI: 10.1093/dote/doaa012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Caustic ingestion, whether intentional or unintentional, may result in significant morbidity. Our aim was to provide an estimate of the incidence and outcomes of caustic ingestion among emergency department (ED) visits across the United States. METHODS The Nationwide Emergency Department Sample (NEDS) is part of the family of databases developed for the Healthcare Cost and Utilization Project. We analyzed NEDS for the period 2010-2014. Adults (≥18 years of age) with a diagnosis of caustic ingestion were identified by ICD-9 codes. The weighted frequencies and proportions of caustic ingestion-related ED visits by demographic characteristics and disposition status were examined. A weighted multivariable logistic regression model was performed to examine factors associated with inpatient admission for caustic ingestion-related visits. RESULTS From 2010 to 2014, there were 40,844 weighted adult ED visits related to caustic ingestion among 533.8 million visits (7.65/100,000, 95% CI 7.58/100,000-7.73/100,000), resulting in over $47 million in annual cost. Among ED visits related to caustic ingestion, 28% had comorbid mental and substance use disorders. Local and systemic complications were rare. There was significant regional, gender, and insurance variability in the decision as to perform endoscopy. Males, insured patients, patients domiciled in the Southeast region of the United States, and patients with mental or substance use disorders had significantly higher percentages of receiving endoscopic procedures. Overall, 6,664 (16.27%) visits resulted in admission to the same hospital and 1,063 (2.60%) visits resulted in transfer to another hospital or facility. The risk factors for admission were increasing in age, male gender, local or systemic complications related to caustic ingestion, and comorbid mental and substance use disorders. A total of 161 (0.39%) patients died related to caustic ingestion. CONCLUSION Our results from NEDS provide national estimates on the incidence of caustic ingestions involving adults seen in US EDs. Further studies are needed to examine the standard management of caustic ingestion and investigate the factors causing variability of esophagogastroduodenoscopy performance and caustic ingestion care.
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Affiliation(s)
- Yiting Li
- Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences, Saint Francis Medical Center, Trenton, NJ, USA
| | - James Langworthy
- Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lan Xu
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Haifeng Cai
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingwei Yang
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuanyuan Lu
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sara L Wallach
- Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences, Saint Francis Medical Center, Trenton, NJ, USA
| | - Frank K Friedenberg
- Gastroenterology and Hepatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Mensier A, Onimus T, Ernst O, Leroy C, Zerbib P. Evaluation of severe caustic gastritis by computed tomography and its impact on management. J Visc Surg 2020; 157:469-474. [PMID: 32088182 DOI: 10.1016/j.jviscsurg.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. PATIENTS AND METHODS In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. RESULTS Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. CONCLUSION CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.
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Affiliation(s)
- A Mensier
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France
| | - T Onimus
- Pôle anesthésie et réanimation, université Lille Nord de France, hôpital Roger-Salengro, CHU de Lille, 59037 Lille, France
| | - O Ernst
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - C Leroy
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France.
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Rana SS, Sharma R, Gupta R. High-frequency miniprobe endoscopic ultrasonography for evaluation of indeterminate esophageal strictures. Ann Gastroenterol 2018; 31:680-684. [PMID: 30386117 PMCID: PMC6191862 DOI: 10.20524/aog.2018.0307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022] Open
Abstract
Background Patients with esophageal stricture who have normal mucosa and whose endoscopic biopsies are inconclusive pose a difficult diagnostic dilemma. We prospectively assessed high-frequency miniprobe endoscopic ultrasonography (EUS) for the evaluation of indeterminate esophageal strictures. Methods Over a period of 3 years, 19 patients (14 male; mean age: 58.9±11.6 years) with indeterminate esophageal strictures were studied using high-frequency miniprobe EUS. The final diagnosis was based on definitive cytopathology, surgical pathology or clinical follow up for more than 6 months. Results The etiology of the esophageal stricture was benign in 10 patients (peptic 2, tubercular 2, drug-induced 2, idiopathic 1, post-pancreatitis 1, post-surgical 1, and IgG4-related sclerosing esophagitis 1), and malignant in 9 patients (squamous cell carcinoma 5, and adenocarcinoma 4). The esophageal stricture was located in the upper, mid and lower esophagus in 1, 9 and 9 patients respectively. The mean length of benign and malignant esophageal strictures was 2.4±1.1 cm and 5.3±1.6 cm, respectively (P=0.0003). EUS was performed successfully without dilatation in all patients. Wall stratification was lost in all patients with malignant strictures and in 3/10 (30%) patients with benign strictures (P=0.03). The mean esophageal wall thickness in malignant and benign strictures was 11.7±2.5 mm and 7.1±2.2 mm, respectively (P=0.0005). A wall thickness ≥9 mm had a sensitivity, specificity, and accuracy of 78%, 80%, and 79%, respectively, for the diagnosis of malignancy. Conclusions High-frequency miniprobe EUS provides important diagnostic information about esophageal strictures. Thicker esophageal walls and a loss of wall stratification are more common in malignant strictures.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble, Grenoble Alpes University, Grenoble, France.
| | - Luigi Bonavina
- University of Milan Medical School, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael D Kelly
- Acute Surgical Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Emile Sarfati
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Department of Digestive and Endocrine Surgery, Saint-Louis Hospital AP-HP, Université Paris Diderot Sorbonne Paris Cité, Paris, France
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Taşkinlar H, Bahadir GB, Yiğit D, Erdoğan C, Avlan D, Nayci A. Effectiveness of endoscopic balloon dilatation in grade 2a and 2b esophageal burns in children. MINIM INVASIV THER 2017; 26:300-306. [DOI: 10.1080/13645706.2017.1298621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hakan Taşkinlar
- Department of Pediatric Surgery, School of Medicine, Mersin University, Mersin, Turkey
| | | | - Doğakan Yiğit
- Department of Pediatric Surgery, School of Medicine, Mersin University, Mersin, Turkey
| | - Cankat Erdoğan
- Department of Pediatric Surgery, School of Medicine, Mersin University, Mersin, Turkey
| | - Dinçer Avlan
- Department of Pediatric Surgery, School of Medicine, Mersin University, Mersin, Turkey
| | - Ali Nayci
- Department of Pediatric Surgery, School of Medicine, Mersin University, Mersin, Turkey
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A Nationwide Population-Based Study of Corrosive Ingestion in Taiwan: Incidence, Gender Differences, and Mortality. Gastroenterol Res Pract 2015; 2016:7905425. [PMID: 26819610 PMCID: PMC4706953 DOI: 10.1155/2016/7905425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 12/30/2022] Open
Abstract
Corrosive injury results from the intake of corrosive-acid-based chemicals. However, this phenomenon is limited to a small number of cases and cannot be extrapolated to the epidemiology of corrosive injuries in actual situations. This study focuses on the annual incidence of corrosive injury and its connection to gender, risk factors, and in-hospital mortality. All patients with corrosive injury (ICD-9 947.0–947.3) were identified using a nationwide inpatient sample from 1996 until 2010. Chi-squared tests and multivariate logistic regression were used to examine risk factors of gender differences and in-hospital mortality of corrosive injury. Young adults comprised the majority of patients (71.2%), and mean age was 44.6 ± 20.9 years. Women showed a higher incidence rate of corrosive injuries, age, suicide, psychiatric disorder, and systemic complications compared with men (p < 0.001). The present study demonstrated that age (OR = 10.93; 95% CI 5.37–22.27), systemic complications (OR = 5.43; 95% CI 4.61–6.41), malignant neoplasms (OR = 2.23; 95% CI 1.37–3.62), gastrointestinal complications (OR = 2.02; 95% CI 1.63–2.51), chronic disease (OR = 1.30; 95% CI 1.08–1.56), and suicide (OR = 1.23; 95% CI 1.05–1.44) were strongly associated with in-hospital mortality. Educational programs may be helpful for reducing the incidence of ingestion of corrosive chemicals.
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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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Abstract
Caustic ingestion continues to be a significant problem world-wide especially in developing countries and particularly in the under 6 years age group. The presence or absence of symptoms or oral lesions does not reliably predict the existence or severity of oesophageal lesions. Upper endoscopy remains the mainstay diagnostic modality for evaluation to define the extent and severity of the injury. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Early management strategies for caustic ingestion are well defined. Controversy still surrounds the use of steroids, antibiotics, antacid therapy in the acute phase, and the use of oesophageal stents and the frequency, timing and method of dilatation in the prevention and management of oesophageal strictures. There is a pressing need for non-invasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion. Indications for definitive surgery or bypass and the type of procedure to use are also subject to ongoing debate.
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Park KS. Evaluation and management of caustic injuries from ingestion of Acid or alkaline substances. Clin Endosc 2014; 47:301-7. [PMID: 25133115 PMCID: PMC4130883 DOI: 10.5946/ce.2014.47.4.301] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 12/13/2022] Open
Abstract
Although the numbers have decreased compared with in the past, cases of patients who ingest caustic substances and visit the emergency room are not rare. However, well-summarized data about caustic injuries are insufficient. Therefore, in this article, I will discuss the etiologic causative agents, injury mechanism, and clinical characteristics, as well as the endoscopic evaluation of the degree of injury and proper management of the patient, in gastrointestinal caustic injury.
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Affiliation(s)
- Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Du C, Chen X, Wang Y, Li J, Yu D. An adaptive 6-DOF tracking method by hybrid sensing for ultrasonic endoscopes. SENSORS 2014; 14:9961-83. [PMID: 24915179 PMCID: PMC4118391 DOI: 10.3390/s140609961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/15/2014] [Accepted: 05/27/2014] [Indexed: 11/16/2022]
Abstract
In this paper, a novel hybrid sensing method for tracking an ultrasonic endoscope within the gastrointestinal (GI) track is presented, and the prototype of the tracking system is also developed. We implement 6-DOF localization by sensing integration and information fusion. On the hardware level, a tri-axis gyroscope and accelerometer, and a magnetic angular rate and gravity (MARG) sensor array are attached at the end of endoscopes, and three symmetric cylindrical coils are placed around patients' abdomens. On the algorithm level, an adaptive fast quaternion convergence (AFQC) algorithm is introduced to determine the orientation by fusing inertial/magnetic measurements, in which the effects of magnetic disturbance and acceleration are estimated to gain an adaptive convergence output. A simplified electro-magnetic tracking (SEMT) algorithm for dimensional position is also implemented, which can easily integrate the AFQC's results and magnetic measurements. Subsequently, the average position error is under 0.3 cm by reasonable setting, and the average orientation error is 1° without noise. If magnetic disturbance or acceleration exists, the average orientation error can be controlled to less than 3.5°.
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Affiliation(s)
- Chengyang Du
- Key Laboratory of Opto-Electronics Information Technology of Ministry of Education, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China.
| | - Xiaodong Chen
- Key Laboratory of Opto-Electronics Information Technology of Ministry of Education, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China.
| | - Yi Wang
- Key Laboratory of Opto-Electronics Information Technology of Ministry of Education, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China.
| | - Junwei Li
- Key Laboratory of Opto-Electronics Information Technology of Ministry of Education, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China.
| | - Daoyin Yu
- Key Laboratory of Opto-Electronics Information Technology of Ministry of Education, College of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China.
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Lurie Y, Slotky M, Fischer D, Shreter R, Bentur Y. The role of chest and abdominal computed tomography in assessing the severity of acute corrosive ingestion. Clin Toxicol (Phila) 2013; 51:834-7. [PMID: 24032468 DOI: 10.3109/15563650.2013.837171] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Corrosive substance ingestion is a toxicological emergency with relatively high mortality requiring rational surgical decisions. OBJECTIVE Evaluate the role of chest and abdominal computed tomography (CT) in assessing the severity of acute corrosive ingestion. METHODS A retrospective study of adults admitted due to corrosive ingestion, who underwent gastrointestinal endoscopy and CT within 48 h of admission. Endoscopy findings were graded as 0, 1, 2a, 2b, 3a, and 3b (Zargar's criteria), CT findings were graded as 0, 1, 2, and 3. For each patient endoscopy and CT grades were compared, and sensitivity and specificity for predicting mortality or emergency laparotomy were calculated. RESULTS Twenty-three patients were included, aged 18-87 years; seven underwent emergency laparotomy, five died. Endoscopy grading was higher than CT grading in 14 patients (66%). The sensitivities of endoscopy grades 2b and 3 to predict mortality and emergency laparotomy were 1 and 0.8, respectively; the specificities were 0.38 and 0.37, respectively. The sensitivities of CT grade 3 to predict mortality and emergency laparotomy were 0.4 and 0.28, respectively; the specificities were 0.94 and 0.93, respectively. Three patients had pulmonary infiltrates on CT but not on chest X-ray. DISCUSSION. CT tends to underestimate the severity of corrosive ingestion compared with endoscopy. It has lower sensitivity and higher specificity than endoscopy in predicting major outcome. CT can provide important information on lung injury, and when endoscopy cannot be completed. CONCLUSION CT should not be the only basis for surgical decisions during the initial phase of acute corrosive ingestions.
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Affiliation(s)
- Y Lurie
- Israel Poison Information Center, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology , Haifa , Israel
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Abstract
Caustic ingestion continues to be a significant problem worldwide especially in developing countries. In 2008 over 200,000 exposures to caustic substances were reported to the National Poison Data System. The presence or absence of symptoms or oral lesions does not predict the existence or severity of lesions. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Upper endoscopy remains the mainstay diagnostic modality for the evaluation of patients with caustic ingestion. There is a pressing need for noninvasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion.
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Affiliation(s)
- Mortada Elshabrawi
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The University of Arizona, Tucson, AZ 85750, USA
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20
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Kannengiesser K, Mahlke R, Ross M, Peters A, Kucharzik T, Maaser C. Isolated jejunal stricture formation two years after corrosive ingestion: case report and review of literature. J Dig Dis 2011; 12:308-11. [PMID: 21791026 DOI: 10.1111/j.1751-2980.2011.00509.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Klaus Kannengiesser
- Departments of Medicine, University Teaching Hospital Lüneburg, Lüneburg, Germany.
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21
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Karagiozoglou-Lampoudi T, Agakidis CH, Chryssostomidou S, Arvanitidis K, Tsepis K. Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome. Dis Esophagus 2011; 24:86-91. [PMID: 20659141 DOI: 10.1111/j.1442-2050.2010.01097.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with caustic substance ingestion are usually referred to surgery departments where endoscopic evaluation is the first step towards appropriate treatment. The aim of this study was to evaluate the safety and efficacy of conservative management of caustic substance ingestion in a pediatric department setting following a standard protocol including endoscopy in selected cases and conservative treatment based on clinical and endoscopy criteria. In this single center observational study, all children admitted for caustic substance ingestion to a pediatric department over an 8-year-period were managed according to a standard protocol that included endoscopy within 24 hours, if the endoscopy criteria were met, and conservative treatment as judged appropriate according to endoscopic classification. Patients were followed up for 8-10 years. Of the 24 patients (age 4/12 to 6 years) admitted, 14 met the endoscopy criteria. Grade II and III esophageal burns were found in 10/14 patients, and they were treated with H2-blockers, antibiotics, corticosteroids, and nutritional support (parenteral in 8/10). Patients with grade II or III esophageal burns necessitated prolonged hospitalization (x ± standard deviation, 23 ± 3 days; range, 21-30 days). Complications included esophageal strictures (n = 1), treated successfully with dilatations, and bleeding (n = 1) treated conservatively. During the 8- to 10-year follow-up all patients were recorded being well. Based on the study findings it is concluded that conservative management of children with caustic substance ingestion using a standard protocol, including endoscopy as indicated, is feasible within the pediatric department, and conservative treatment on demand is safe and effective in preventing short-term and long-term complications.
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22
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Chou SH, Chang YT, Li HP, Huang MF, Lee CH, Lee KW. Factors predicting the hospital mortality of patients with corrosive gastrointestinal injuries receiving esophagogastrectomy in the acute stage. World J Surg 2011; 34:2383-8. [PMID: 20512491 DOI: 10.1007/s00268-010-0646-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify the preoperative factors that affect the survival of patients who undergo esophagogastrectomy after corrosive ingestion, using analysis of their physiological condition, associated diseases, physical examination, and laboratory data. METHODS Between January 1995 and December 2005, 71 consecutive patients who underwent esophagogastrectomy for corrosive ingestion injuries were retrospectively reviewed. Of them, 41 survived and 30 (42.3%) died during the perioperative period. Logistic regression analyses were used to model markers for postoperative mortality, including descriptive data, clinical symptoms/signs, and laboratory data. RESULTS There were 35 males and 36 females included in the study, with an average age of 54.7 +/- 14.9 years. After adjustments in the logistic regression model, age of over 65 years (p = 0.021), presence of gross hematuria (p = 0.016), twofold level of serum AST (p = 0.012), blood pH level below 7.2 (p = 0.017), and deficit of blood base over 16 (p = 0.007) were found to be independent risk factors for patient mortality. CONCLUSIONS We consider age over 65 years, preoperative pH < 7.2, base deficit >16, twofold level of serum AST, and presence of gross hematuria to be the important factors predicting postoperative hospital mortality in patients presenting with corrosive ingestion injuries who require emergency surgery.
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Affiliation(s)
- Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
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Atiq M, Kibria RE, Dang S, Patel DH, Ali SA, Beck G, Aduli F. Corrosive injury to the GI tract in adults: a practical approach. Expert Rev Gastroenterol Hepatol 2009; 3:701-9. [PMID: 19929589 DOI: 10.1586/egh.09.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Corrosive injury to the GI tract still poses great challenges with regards to the initial evaluation triage, as well as the optimization of medical management. Although relatively uncommon in the adult population, these injuries can cause significant morbidity and serious sequelae of complications, such as esophageal strictures and cancer. Prompt recognition of the process and aggressive measures towards the stabilization of the patient are key to a favorable outcome.
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Affiliation(s)
- Muslim Atiq
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Science, 4301-West Markham Street, ML 567, USA
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24
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Tan QY, Wang RW, Jiang YG. Strengthening the understandings on corrosive esophageal burn and prevention and management of corrosive esophageal stricture. Shijie Huaren Xiaohua Zazhi 2009; 17:637-641. [DOI: 10.11569/wcjd.v17.i7.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Caustic esophageal injuries are corrosive burns of esophagus mostly caused by ingestion of chemical caustic substances such as strong acid or alkali. There is often "saddle" dysphagia following three pathologic phases after injury. In addition to early emergency treatment, it is very important to prevent corrosive esophageal stricture by medication, dilation, stenting and so on. Different surgical operations can be selected for those with cicatrix stricture of esophagus. In this paper, we comment on the causes, pathology, diagnosis of caustic esophageal injury and prevention and management of corrosive esophageal stricture.
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Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, Chen PC. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8:31. [PMID: 18655708 PMCID: PMC2533005 DOI: 10.1186/1471-230x-8-31] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 07/25/2008] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract which include extensive necrosis and perforation of the esophagus and stomach. The gold standard of safely assessing depth, extent of injury, and appropriate therapeutic regimen is esophagogastroduodenoscopy (EGD). The objective of this study was to report our clinical experience and to evaluate the role of a 6-point EGD classification system of injury in predicting outcomes in adult patients diagnosed with caustic agent ingestion. METHODS The study was a retrospective medical chart review from 273 patients admitted to the Chang Gung Memorial Hospital in Tao-Yuan, Taiwan between June 1999 and July 2006 for treatment of caustic ingestion. The patients underwent EGD within 24 hours of admission and mucosal damage was graded using Zagar's modified endoscopic classification scheme. After treatment, patients were followed in the outpatient clinic for a minimum of 6 months. RESULTS A total of 273 patients were included for analysis. Grade 3b injury was the most common caustic injury (n = 82, 30.03%), followed by grade 2b injuries (n = 62, 22.71%). Stricture was the most common complication (n = 66, 24.18%), followed by aspiration pneumonia (n = 31, 11.36%), and respiratory failure (n = 21, 7.69%). Compared to grade 3a mucosal injury, grade 3b mucosal injuries were at greater risk of prolonged hospital stay (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25-4.80), ICU admission (OR: 10.82; 95% CI: 2.05-200.39), and gastrointestinal (OR: 4.15; 95% CI: 1.55-13.29) and systemic complications (OR: 4.07; 95% CI: 1.81-14.07). CONCLUSION In patients with caustic ingestion, EGD should be performed within 12 to 24 hours and categorized according to a 6-point scale. Patients with grade 3b burns identified on endoscopy have high rates of morbidity. The 6-point scale is useful for predicting immediate and long-term complications, and guiding appropriate therapy.
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Affiliation(s)
- Hao-Tsai Cheng
- Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
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Pace F, Pallotta S, Antinori S. Nongastroesophageal reflux disease-related infectious, inflammatory and injurious disorders of the esophagus. Curr Opin Gastroenterol 2007; 23:446-51. [PMID: 17545784 DOI: 10.1097/mog.0b013e32818a6d8b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW To review recently published studies presenting novel and relevant information on some esophageal infectious, inflammatory and injurious diseases. RECENT FINDINGS In the treatment of Candida esophagitis, fluconazole remains the treatment of choice, but clinical failures indicate new therapeutic opportunities, like two new echinocandins, micafungin and anidulafungin. Eosinophilic esophagitis is an increasingly recognized entity. New therapeutic insights come from a six-food elimination diet in children and from fluticasone propionate in adults; humanized monoclonal IgG antibody anti-interlukin-5, mepolizumab, has been shown to decrease eosinophilia and ameliorate symptoms. There has been some advance in microscopic characterization of lymphocytic esophagitis. Esophagitis is found to be present in 67% of patients with pemphigo vulgaris, in 32.3% of patients with systemic sclerosis and to be associated with thoracic neoplasias. In the case of caustic ingestion, endoscopic ultrasound with miniprobes has proven not to be better than videoendoscopy. Recent evidence shows that systemic steroids might even be harmful. Mitomycin C applied on fresh wounds is currently being evaluated. Stenting of the stricture has been proposed for contrasting esophageal remodeling. SUMMARY These recent findings, together with a better understanding of diseases such as eosinophilic or lymphocytic esophagitis, allow new diagnostic and therapeutic approaches.
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Affiliation(s)
- Fabio Pace
- Division of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy.
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Kamijo Y, Kondo I, Watanabe M, Kan'o T, Ide A, Soma K. Gastric stenosis in severe corrosive gastritis: prognostic evaluation by endoscopic ultrasonography. Clin Toxicol (Phila) 2007; 45:284-6. [PMID: 17453882 DOI: 10.1080/15563650601031759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Endoscopic ultrasonography can provide high-resolution images of the gastric wall. CASE REPORT A 24-year-old woman with severe corrosive gastritis following massive ingestion of an alkaline household chemical was examined with endoscopic ultrasonography using a 20-MHz probe. Endoscopic ultrasonography disclosed diffuse thickening of the entire gastric wall and lack of demarcation of the muscular layer in the antrum. Several weeks after the ingestion, stenosis developed in the antrum and was treated with laparoscopic gastrectomy. DISCUSSION Endoscopic ultrasonography can provide accurate evaluation of depth of lesions in corrosive gastritis and may be useful in predicting gastric stenosis.
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Affiliation(s)
- Yoshito Kamijo
- Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine, Sagamihara, Kanagawa, Japan.
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Salzman M, O'Malley RN. Updates on the Evaluation and Management of Caustic Exposures. Emerg Med Clin North Am 2007; 25:459-76; abstract x. [PMID: 17482028 DOI: 10.1016/j.emc.2007.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 2004, the American Association of Poison Control Centers' Toxic Exposure Surveillance System documented over 200,000 exposures to caustic substances, in both household and industrial products. Although the most commonly affected body areas are the face, eyes, and extremities, all reported fatalities were as a result of ingestion. Little controversy exists in patient management following dermal or ocular caustic exposure. Immediate water irrigation of the site of caustic exposure, followed by routine burn care, analgesia, intravenous fluids, and electrolyte replacement are standards of care. In this manuscript, a thorough review of the management of gastrointestinal caustic exposure is explored, not only because of the high rates of morbidity and mortality associated with these exposures, but also because there remains controversy regarding appropriate management of such exposures. Hydrofluoric acid, a weak acid in its aqueous form, requires special consideration and specific antidotes, and as such, is addressed separately.
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Affiliation(s)
- Matthew Salzman
- Department of Emergency Medicine, Albert Einstein Medical Center, Korman Building B-6, Philadelphia, PA 19141-3098, USA.
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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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