Management of Accidental Ingestions of Caustic Products in Emergency Departments in Dakar : About 31 Cases

Abstract

Background: Caustics are corrosive substances whose ingestion causes tissue damage that can range from mucosal irritation to total necrosis or even perforation of the affected digestive or bronchial segment. Ingestion is often accidental in children and a real public health problem in low and middle income countries, particularly in Africa.
 Aims: The main objective of this study was to describe the epidemiological, diagnostic, therapeutic and scalable aspects of accidental ingestions of caustics in the medical emergency department of the National Children's Hospital Center Albert Royer (NCHCAR) in Dakar.
 Methods: This is a descriptive and analytical study over a 12-month period, from March 2020 to February 2021. The study population was children aged 0 to 15 years who were seen in consultation or hospitalized following a caustic product ingestion.
 Results: During the study period, we included 31 children for accidental ingestion of caustics out of a total of 900 hospitalized children, i.e., a hospital frequency of 3.44% (31/900). The mean age of the children was 21.29±13.10 months and the extremes were 8 and 60 months. The age group [12-18 months] was the most represented (25.81%). Boys were predominant (51.61%) with a sex ratio of 1.07. Sodium hypochlorite (bleaching water) was the main product ingested (64.52%); caustic soda concerned 22.58% of children. More than half (77.45%) of the children were symptomatic with mainly digestive signs including oral ulcerations (41.93%) and vomiting (38.71%). The oesogastroduodenal fibroscopy performed in 19 of the 31 children (61.29%) was normal in 14 children (73.68%). Five children had endoscopic lesions of which 2 cases were stage I and 3 cases stage IIa of the Zargar classification. Initial management was exclusively medical with antisecretory drugs (70.97%), analgesics (38.71%) and corticosteroids (35.48%). The evolution was favorable for the majority of patients. One child presented a dysphagia to solids after 4 weeks of evolution treated by endoscopic dilatation. 
 Conclusion: Accidental ingestions of caustics are frequent in emergency departments. They generally affect children under 24 months of age. The management is medical in the uncomplicated forms which are more and more predominant. Prevention is based on education and awareness of the dangers of caustic products.