Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries

Contini, Sandro; Swarray‐Deen, Alim; Scarpignato, Carmelo

doi:10.2471/blt.08.058065

Cited by 81 publications

(85 citation statements)

References 11 publications

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“…Family organization classiied as extended implies crowded living conditions and enables both parents to work outside home while other family members take care of their children [18]. Other authors have reported that unsafe homes where safety rules regarding caustic substances are lacking have been identiied as a substantial risk factor for CI in children [1,9,13,17,21]. Sarioglu-Buke et al found that children from families where both parents with low educational level and low socioeconomic status had a higher risk for a CI event.…”

Section: Epidemiologymentioning

confidence: 99%

“…In 1985, Wasserman reported that approximately 5000 children younger than 5 years ingested lye each year in the United States [2]; in 2008, the USA National Poison Data reported over 200,000 exposures to caustic substances [3]. Unfortunately, the true prevalence regarding this health problem is not known in most developing countries and cannot be extrapolated from publications of series of children with CI treated in paediatric hospitals; however, these publications describe demographic, clinical and treatment characteristics of children from low, lower-middle and high-income countries information is scarce specially in lower-middle income countries [1].…”

Section: Epidemiologymentioning

confidence: 99%

“…Although is not a public health problem, CI is a signiicant issue worldwide, particularly in developing countries in which an unsafe environment is a substantial risk factor for child injury [1]. In 1985, Wasserman reported that approximately 5000 children younger than 5 years ingested lye each year in the United States [2]; in 2008, the USA National Poison Data reported over 200,000 exposures to caustic substances [3].…”

Section: Epidemiologymentioning

confidence: 99%

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Caustic Ingestion in Children

Larrosa‐Haro¹,

Sánchez-Ramírez²,

MMesa-Magaña³

et al. 2017

Esophageal Abnormalities

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Caustic ingestion (CI) is an unfortunate event that occurs in families with a poor prevention culture. Its prevalence is unknown in developing countries; it occurs mainly in children < 5 years and is more common in boys. The chemical caustic agents are alkaline (85%) or acid products stored in food or beverage containers without warning labels and safety caps. The immediate symptoms include salivation, oropharyngeal burns, vomiting and oropharyngeal/retrosternal pain. Upper endoscopy is the irst-line tool to identify the type and extension of oesophageal and gastric damage. A barium swallow performed 2-3 weeks after the CI may identify oesophageal stricture. Dysphagia occurs in about one-third of cases. Regarding the nutritional status, children with dysphagia and/or oesophageal strictures may have lower fat reserves or muscle mass than the cases without these complications, meaning impaired nutritional status. All patients should be hospitalized for evaluation and treatment. Hemodynamic stabilization and adequacy of the patient's airway are priorities; vomiting induction and gastric lavage are contraindicated. Methylprednisolone in II-b oesophageal burns for 3 days diminishes the risk of stricture. Selected cases will require oesophageal dilatations, gastrostomy or oesophageal replacement by colon or stomach. There are other promising agents in the management of caustic oesophageal strictures.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

See 1 more Smart Citation

Caustic Ingestion in Children

Larrosa‐Haro¹,

Sánchez-Ramírez²,

MMesa-Magaña³

et al. 2017

Esophageal Abnormalities

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“…In these countries CI are more common than in westernized nations, in part because of the use of secondary containers and the availability of chemicals around the home. 15 In addition, with the westernization of developing nations and a rise in atopic diseases where food allergy was previously uncommon, the need to differentiate between CI and anaphylaxis in these settings is increasingly important. 16 …”

Section: Discussionmentioning

confidence: 99%

Caustic Ingestions Mimicking Anaphylaxis: Case Studies and Literature Review

Sherenian¹,

Clee²,

Schondelmeyer³

et al. 2015

Pediatrics

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Anaphylaxis presents in children with rapid involvement of typically 2 or more organ systems including cutaneous, gastrointestinal, and respiratory. Caustic ingestions (CI) may also present with acute involvement of cutaneous, gastrointestinal, and respiratory systems. We present 2 cases of "missed diagnosis" that illustrate how CI presenting with respiratory symptoms can be mistaken for anaphylaxis owing to these similarities. Both of these patients had delay in appropriate care for CI as a result. These cases demonstrate the importance of considering CI in children who have gastrointestinal symptoms, respiratory distress, and oropharyngeal edema.Anaphylaxis presents with a combination of gastrointestinal, cardiovascular, respiratory, and cutaneous symptoms. 1 The estimated incidence of pediatric anaphylaxis is ∼1 per 1000 children per year. 2 Caustic ingestions (CI) also present with respiratory distress, vomiting, and oral edema. The incidence of CI is lower, at ∼1 per 100 000 children per year. 3 Many CI cases are accidental; bleach, disinfectants, and laundry detergents are the most common agents. 4 We report 2 children misdiagnosed with anaphylaxis after unrecognized CI. CASE DESCRIPTIONS Patient APatient A was a 5-year-old boy who had asthma and eczema who presented with coughing and lip and tongue swelling immediately after eating dinner. Over the following 4 to 6 hours, he developed vomiting, drooling, and audible wheezing. His mother called emergency medical services and reported that he was having trouble breathing. Initial emergency department (ED) examination revealed respiratory distress, stridor at rest, drooling, and an oxygen saturation of 89% by pulse oximetry. In the ED, neck films revealed minimal tracheal narrowing and epiglottal thickening. He was given dexamethasone, diphenhydramine, and nebulized racemic epinephrine without improvement. His respiratory status worsened, requiring intubation. A swollen glottis was noted during the procedure.He was transferred to our tertiary care hospital for intensive care management. Because of his atopic medical history and presentation, he was tentatively diagnosed with refractory anaphylaxis and given diphenhydramine and intramuscular (IM) epinephrine. Examination revealed tongue edema and evidence of stomatitis, atypical for anaphylaxis but concerning for infection or trauma. His mother denied awareness of chemical ingestions or recent fever. A rapid screen for group A b-hemolytic Streptococcus was positive. A diagnostic evaluation for allergic reaction returned a negative tryptase level and negative serum-specific

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“…Accidental ingestion of corrosive substances is more commonly seen in early childhood with children younger than fi ve years being more prone to such ingestion 1,2,3,4,5,6 . Ingested corrosives are either acids or alkali 7 .…”

Section: Introductionmentioning

confidence: 99%

Esophageal Stricture Post Accidental Corrosive Ingestion: A Case Report

Joshi

Lamichhane

Ghimire

2017

J. Nepal Paedtr. Soc.

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Corrosive substance ingestion is a seriouspublic health hazard. Mostly, children are victim due to accidental ingestion occurring commonly in less than five years. Whether acid or alkali, the ingestion may have catastrophic effects and the outcomes can vary from minimal injury to perforation and death. Esophagogastroduodenoscopy should be done 12-24 hours of ingestion in order to assess the extent of mucosal injury. Esophageal stricture remains one of the major sequel usually seen after three weeks of ingestion. Endoluminal dilatation is current recommendation for initial treatment of stricture and surgery should follow for strictures refractory to dilatation. We here present a case of a five year old child with accidental corrosive ingestion at her school which led to esophageal stricture. She underwent multiple dilatation of stricture followed by esophageal corrective surgery which again led to post-surgical stricture requiring further dilatations.

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Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries

Cited by 81 publications

References 11 publications

Caustic Ingestion in Children

Caustic Ingestion in Children

Caustic Ingestions Mimicking Anaphylaxis: Case Studies and Literature Review

Esophageal Stricture Post Accidental Corrosive Ingestion: A Case Report

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