Caustic Digestive Lesions in Adults: Epidemiological, Endoscopic and Therapeutic Aspects at Idrissa Pouye General Hospital (Dakar, Senegal)

Abstract

Introduction: Ingestion of caustic products is a diagnostic and therapeutic emergency. Its severity is related to the risk of death and digestive functional sequelae. Common in children, following accidental ingestion, many studies have been devoted to it in the pediatric environment. However, data on adult populations are rare in our context. The aim of this work was to describe the profile of patients hospitalized for caustic ingestion, the context of occurrence, the endoscopic lesions observed, their evolution and their therapeutic modalities. Patients and methods:This was a descriptive retrospective study in the Hepato-Gastroenterology Department of the Idrissa Pouye General Hospital (HOGIP) over a period of 8 years (March 2008-March 2016. The records of patients over 15 years old, hospitalized for caustic ingestion were collected. The age, sex, circumstances of occurrence, nature of the caustic, consultation and endoscopy time, endoscopic lesions and their therapeutic modalities were studied. Results:Of the 2750 patients hospitalized during the study period, 25 were admitted for ingestion of digestive caustic products, corresponding to a prevalence of 0.9%. Three records were not searched. The following data were obtained from the analysis of 22 records. The mean age was 36.5 years (range: 16-82 years) with a sex ratio of 0.7 (13 females). Ingestion of the caustic was voluntary in 16 cases (11 women). The main motivations for the women were family conflicts. A regular intake of hallucinogenic substances (Indian hemp) was noted in 80% of men who voluntarily ingested a caustic product. Caustic soda was the product most often incriminated. The average quantities of caustic ingested were respectively 100cc and 300cc depending on whether the ingestion was accidental or voluntary. The median consultation time was 5 hours (30min-28d) and the median endoscopy time was 48 hours (16h-70d). The main acute esophageal lesions objectified were grade IIB (46.8%) and IIIA (37.3%) according to Di Costanzo's classification. At the gastric level, grade I and IIa lesions were present in 36.4% and 43% of cases respectively. Control endoscopy revealed esophageal or gastric stenosis in 8 cases (36.4%) and 2 cases (9%) respectively. Therapeutically, a total diet was instituted in all patients. The average duration of the diet was 15 days (2 days -21 days). Parenteral nutrition was introduced in 5 patients (22.7%). PPI therapy and rehydration were the standard treatment in all patients. Eight patients received endoscopic esophageal dilations. The mean number of dilation sessions was 4 (range: 2-11). Gastroentero anastomosis was performed in 2 patients. One case of death was recorded at D7 of hospitalization following septic shock in a patient with grade IIIB esogastric lesions of Di Costenzo. Conclusion:The ingestion of caustic products in the hospitalization unit of the Hepato-Gastroenterology Department of Idrissa Pouye General Hospital is more frequent in women, most often related to an attempt at autolysis in the context of fami...

Accidental Ingestion of Nitric Acid in an Agricultural Company: A Case Study and Literature Review

“…Our patient presented a lesion classified as 2a. This is a frequent level found in studies in Senegal and Nigeria [10] [17] [18]. As in our case, control OGDF of these lesions were often normal.…”

“…Acid is the most frequent substance involved in cases of caustic ingestion in Europe and Asia and in some African countries [1] [14] [17]. But in Senegal and many other West African countries, caustic soda was in the forefront due to its accessibility and widespread domestic use [10] [13] [18]. In the agricultural industry, we have not found any cases of accidental or deliberate ingestion of caustic soda.…”

“…Again, more than 70% of these ingestions in adults were attempted autolysis [16]. In Dakar, 25 cases of caustic ingestion were recorded in 8 years, representing a prevalence of 0.9% in the hepato-gastroenterology department of the Hôpital Général Idrissa POUYE, with 64% of these cases being self-inflicted [10].…”

“…The aim is to prevent any worsening of the lesions and to preserve vital functions [1] [19]. Consultation times range from a few hours to several days [10] [19]. In Dakar, the earliest consultations were within the first 30 minutes, with an average delay of 5 hours.…”

“…In Senegal, the caustic ingestion is said to be underestimated, due to poor notification systems. Twenty-two (22) cases were recorded in 8 years in Dakar [10].…”