Management of esophageal caustic injury

Abstract

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

A rare case report of oesophagocoloplasty with distal colo-jejunal anastomosis in the management of post corrosive strictures of the oesophagus

“…4 The relationship between symptoms and severity of the injury is uncertain, expectant management and thorough evaluation of injuries in such patient is necessary. 5 In this case, patient was haemodynamically stable at the time of presentation, but injuries were much more extensive than expected. Since patient was worsening clinically and radiological evidence suggestive of hollow viscus perforation, patient had to underwent exploratory laparotomy.…”

Nursing Care in Corrosive Esophageal Injuries in Children

“…Ergenlerde ise intihar amacıyla bu yaralanmalar görülmektedir. 5 Koroziv özofagus yaralanma insidansı çocuklarda tam olarak bilinmemekle birlikte, dünyada yılda ortalama 100.000 kişi içinde 518 çocuğun koroziv madde nedeni ile yaralandığı bildirilmektedir. 4,6 İngiltere'de her yıl 40.000 çocukta koroziv özofagus yaralanmaları tespit edilmiştir.…”

“…4 Tüm koroziv özofagus yaralanmalarında temel olarak havayolu açıklığı ve hemodinamik stabilizasyon sağlanmalıdır. 1,3,5 Çocuğun epiglottisi ve larinksi ödemli ise havayolu açıklığını sağlamak için hekim tarafından entübasyon veya trakeostomi açılması açısından değerlendirilmelidir. 3 Özofageal hasarı en aza indirmek için bazen hekim tarafından proton pompa inhibitörleri ve H 2 reseptör blokerleri başlanabilir.…”

“…31 Bu dönemde önemli olan, koroziv özofagus striktürünün endoskopik dilatasyonlar ile primer cerrahi dışı tedavisini sağlamaktır. 4,5 Hekim tarafından dilatasyon programı, üç hafta içinde başlamazsa fibrotik stenoz kötüleşebilir. Dilatasyon yapılan çocukta komplikasyon olarak perforasyon, kanama, sepsis ve beyin apsesi gelişebilir.…”

Stenting the cutter tension after chemical burn in children: a review of literature and own experience

“…Наиболее часто проглатываемые едкие вещества личество лейкоцитов (>20х10 9 л), наличие язвы или некроза желудка являются независимыми предикторами смерти. Лабораторные тесты играют более важную роль в ведении пациентов, а не в прогнозировании заболеваемости или смертности [1,4].…”